Ethical decision making at the end of life: the role of religious traditions and public policy.
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A recent important and poorly publicized legal case in California raised the question of whether the wife of a severely mentally disabled man could intentionally withhold medically supplied nutrition from him on the grounds that it was no longer providing benefits. Rita L. Marker has published a detailed case report and analysis. The readers of the Newsletter on Ethics and Intellectual Disability should know about her analysis. A summary is presented here together with some observations about the issues the case raises. Readers are encouraged to consult the original article: Rita L. Marker, "Mental Disability and Death by Dehydration." National Catholic Bioethics Quarterly 2 (Spring 2002): 125-36. All quotations are from the Marker analysis.
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Ethics committees are use [sic] to questions concerning the withdrawal of life-support. Such questions become increasingly complex when that life-support is implantable, like a pacemaker. This essay seeks to address the question of under what, if any, circumstances it would be permissible to discontinue the use of such implantable devices.
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Death cannot be viewed properly as either an event or a configuration. Indeed, multiple parts of the body can continue to live long after the disintegration of its central organization is recorded. Instead of collapsing at a moment in time, technological mechanisms are capable of sustaining the major bodily processes indefinitely--all designed to allow for the harvesting of needed organs for transplantation. State legislative efforts have been undertaken in America to define those specific circumstances when death occurs legally. Although always allowed to exercise reasonable discretion in their decision making, attending physicians will nonetheless be aided by these laws that only limit their legal liability but assure for the patient that his final choices will be honored consistent with basic principles of self-determination. The Law Reform Commission of Canada recommended in 1987 that criminal liability be rejected for the offenses of helping, advising, or inciting a person to commit suicide. This is an exceedingly wise and humane position to follow. Instead of being held captive to words such as "rational suicide" or "euthanasia", what is needed is an acceptance of more contemporary watchwords such as autonomy and self-determination. When at all possible, final choices about death should be made by the patient's family and their medical advisers--and not be subjected to judicial scrutiny.
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