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PubMed1994

Euthanasia in Holland: an ethical critique of the new law.

In the Netherlands the government's proposal for the legal regulation of euthanasia, assisted suicide and the termination of a patient's life without request has been approved by Parliament. The defence of this proposal is to a large extent based on a specific interpretation of data about the practice of euthanasia in that country, published in 1991 (the Remmelink Report). This paper discusses both the interpretation of the data and the new law. On the basis of that and other data, the author concludes that many cases of euthanasia, assisted suicide and termination of a patient's life without request remain unnotified and therefore unreviewed by the legal authorities. It is argued that the new law will not guarantee an improvement to this situation. In short, the new law will not protect effectively the lives of patients, and must, therefore, be open to ethical and legal objection.

Ethics, Medical↗
PubMedDate not supplied

Psychiatric evaluation of death-hastening requests. Lessons from dialysis discontinuation.

The authors aim to facilitate the psychiatric evaluation of death-hastening decisions, such as cessation of life-support treatment or physician-assisted suicide, by deriving principles for evaluating patients from a literature review and a recently completed prospective study on dialysis discontinuation conducted by consultation psychiatrists. Factors are delineated and suggestions are provided for the evaluation of requests to accelerate dying. Included are the authors' method for determining major depression in the context of terminal illness and their "vector analysis" in assessing patient requests to stop dialysis. As our society heatedly examines the care provided to the terminally ill, psychiatry also needs to reconsider whether actions that foreshorten life can be normative and permissible. Familiarity with competency, psychiatric diagnosis, and ease in communication and negotiation between patient, family, and staff are resources that psychiatrists can bring to these complicated assessments. Challenging areas include diagnosing depression, establishing the adequacy of palliative care, and appreciating issues related to personality features, family dynamics, and ethnic differences.

Major Depressive Disorder↗
PubMed1982

The do-not-resuscitate order in a teaching hospital: considerations and a suggested policy.

We present a policy for implementing the do-not resuscitate orders by medical residents in a teaching hospital, and discuss decision making, legal and ethical considerations, the primary physician's responsibility, and record documentation. THe establishment of a policy and procedure for implementing do-not-resuscitate orders resulted in greater consideration of patient and family rights and improved communication and sensitivity in dealing with those concerned with the patient's medical care and welfare.

Decision Making↗
PubMedDate not supplied

Balancing benefit and burden. Merely avoiding harm does not carry out the intent of the Hippocratic Oath.

Healthcare providers often seek to benefit their patients through the avoidance of harm. This approach to benefit is rooted in the common understanding of the Hippocratic oath as primum non nocere--first, do no harm. A need exists in medical-ethical decision making to rediscover the principle of benefit per se, independent of the principle of avoiding harm. In healthcare the invasive, painful, costly, or repugnant nature of the treatment reflects the burden. Benefit, on the other hand, is personal. Rev. Gerald Kelly, SJ, moved away from considering objective burdens as the principal factor in determining the ethical status of a treatment and toward the presence or absence of some benefit. He also gave insight into the nature of this benefit: The treatment being considered should have a reasonable chance of offering a "remedial" effect. Recent literature has considered the "extent" of improvement as an important element in determining whether a treatment is of benefit. Not just any improvement justifies the treatment, but an improvement that fulfills the patient's reasonable expectations. The Declaration on Euthanasia states that if a treatment will or does fall short of expectations, it may be withheld or withdrawn on the grounds that the burdens involved are disproportionate. To understand a treatment as having proportionate value, one must also take into account that aspect of benefit which has not resulted.

Beneficence↗