Search

Preservation of a life filled with suffering, or emptiness, is now possible with modern life-sustaining methodologies, and the case of Nancy Cruzan is an example of the 'dark' side of medicine's technological power. This 32-year-old woman has been in a persistent vegetative state for seven years since a car accident, with a hopeless prognosis. Her cerebral cortex has atrophied; she is not dead; and she can probably live as she is for many years more, at a cost of $130,000 a year to the state of Missouri and immeasurable suffering to her family. In 1987, her parents requested that Nancy's feeding tube be removed so she could die. A lower court granted the request, but the Missouri Supreme Court reversed the decision, based on the state's 'unqualified' interest in the preservation of life. The U.S. Supreme Court is currently debating the case, based on arguments heard in December 1989. The decision on the Cruzan case is crucial for the future of life-sustaining care in the United States. The argument is made that the decision of the Missouri Supreme Court should be reversed; in part, because the lower court applied a formula to the problem without awareness of the complexities that modern technology has introduced. In addition, the state of Missouri has a death penalty, and denies lifesaving bone marrow transplants to some children who cannot afford them - transplants that could be paid for out of the money spent yearly on Nancy. Thus, its position has not been one of unqualified interest in preserving life. Three questions should be considered in treating patients such as Nancy. Would this person, who cannot decide whether to accept a medical treatment, choose to live? If life-sustaining treatments are to be withheld, who should decide? Third, should courts be involved in such decisions? One proposal by Missouri's attorney general suggests authorization of removal of life-sustaining treatments by families for patients who have been in a persistent vegetative state for two to three years, unless the patient previously expressed a wish to be kept alive under all conditions. There are approximately 10,000 patients in a vegetative state in the United States, many of whom are conscious and suffering. No one is sure who has the authority to end these people's lives. Healthy older people may become depressed by the possibility of living in such a condition with no control over its outcome. Surely, the situation where people are more afraid to live than to die is one that cries for remediation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Today Thailand is frequently referred to as one of the newly industrialized countries (NICS). The present ambition of Thai policy-makers is to move the country toward realizing its economic and [...]

Second only to abortion, euthanasia is the question which most students opt to answer in practical ethics examinations. It is, of course, an issue of continuing debate and hardly a […]

ANGEL OF DARKNESS or angel of light? The name Jack Kevorkian evokes a variety of responses from people across the United States. At one end of the spectrum, the name [...]

An important part of the debate over physician-assisted suicide concerns moral duties that are specific to physicians. It is sometimes argued that physicians, by virtue of special commitments rooted in the nature of their profession, may never intentionally kill a patient, and that therefore, whether or not assisted suicide may be justifiable, it can never be right for a physician to take part in such an act. I examine four types of argument that have been offered in support of this conclusion, and find that none succeeds. Each attempts to show why the duty to conserve life must be unconditional for physicians, yet a consideration of the ways in which contemporary medicine has evolved shows that such a duty is now no more fundamental to the profession than a duty to relieve suffering, which may in some cases override it. Key words: essentialist, euthanasia, Hippocratic tradition, special duty

Walter Benjamin once said that authors should write the article or book they looked for in the literature but could not find. Because so much has been written about assisted [...]

The purpose of the study was to explore meanings of euthanasia, including the forms of active, passive, voluntary, involuntary, and physician-assisted death as described by 19 elderly Israelis and their [...]

Pharmacists are in a critical position when pharmaceutical agents are prescribed for the purpose of physician-assisted suicide and/or euthanasia and they may need to decide whether dispensing a lethal dose of a medication is ethically and morally acceptable for a patient. In many cases, pharmacists may not even be aware that prescriptions are intended for physician-assisted suicide and/or euthanasia. Pharmacists have a special responsibility to protect patients who are contemplating end-of-life decisions such as physician-assisted suicide and euthanasia. Pharmaceutical care ('Responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life ...') requires that the pharmacist not only understands the medications but also the individual patient and the complexities of their lives and suffering. Only in this way can pharmacists provide safe and effective use of medications for the patients they serve.

Euphemisms are place-holders for important concepts. They may disguise a practice which one might abhor if it were given another name. In Nazi Germany during World War II, euphemisms were used to desensitize physicians and society to the horrors of a program of euthanasia. This article examines some of the euphemisms used by the Nazi physicians to redefine medicalized killing, compares the Nazi language games with those of contemporary proponents of medicalized killing, and concludes that the consistent application of euphemisms for medicalized killing significantly weakens arguments against assisted killing. We should watch the way we talk. Human society can be described as a long conversation about what matters. In this conversation, the language we use to describe our social practices not only reveals our attitudes and virtues, it shapes them (Winslow, 1994, p. 1).

A qualitative case study was conducted to explore the clinical decision making processes that underpinned the practice of euthanasia under the Rights of the Terminally Ill (ROTI) Act. The key informant for this research was Philip Nitschke, the general practitioner responsible for the legal cases of euthanasia. His information was supported by extensive document analysis based on the public texts created by patients in the form of letters and documentaries. Further collaborating sources were those texts generated by the media, rights groups, politicians, the coroner's court, and the literature on euthanasia and assisted suicide. A key study finding was that the ROTI legislation did not adequately provide for the specific medical situation in the Northern Territory, Australia. The medical roles, as proscribed by the legislation, carried many inherent assumptions about the health care context and the availability of appropriately qualified medical staff committed to providing euthanasia. These assumptions translated into difficulties in establishing clinical practices for the provision of euthanasia. A further finding concerned the motivations of those who requested euthanasia. This article addresses the medical roles and the motivations of those seeking euthanasia.

Throughout recorded history, a series of seemingly unrelated ideas have been consistently intertwined: suicide, euthanasia, infanticide, eugenics, genocide and, most recently, the practice termed physician-assisted suicide. From Plato and Hippocrates to a pair of twentieth-century American physicians named Haiselden and Kevorkian, an examination of history shows these disparate notions always involve two troublesome questions: Which lives are not worth living? And who will decide? The same examination of history teaches that separating the worthy from the not worthy is a very dangerous proposition, especially for those whose lives are deemed marginal.

During the past twenty-five years in the Netherlands, a practice of helping patients to die has been developed that is unique in the world. Euthanasia has not been formally legalized, [...]