Physician-assisted suicide: the legal slippery slope

Physician-Assisted Suicide: Why Neutrality by Organized Medicine Is Neither Neutral Nor Appropriate

It has been proposed that medical organizations adopt neutrality with respect to physician-assisted suicide (PAS), given that the practice is legal in some jurisdictions and that membership is divided. We review developments in end-of-life care and the role of medical organizations with respect to the legalization of PAS since the 1990s. We argue that moving from opposition to neutrality is not ethically neutral, but a substantive shift from prohibited to optional. We argue that medical organizations already oppose many practices that are legal in many jurisdictions, and that unanimity among membership has not been required for any other clinical or ethical policy positions. Moreover, on an issue so central to the meaning of medical professionalism, it seems important for organized medicine to take a stand. We subsequently review the arguments in favor of PAS (arguments from autonomy and mercy, and against the distinction between killing and allowing to die (K/ATD)) and the arguments against legalization (the limits of autonomy, effects on the patient-physician relationship, the meaning of healing, the validity of the K/ATD distinction, the social nature of suicide, the availability of alternatives, the propensity for incremental extension, and the meaning of control). We conclude that organized medicine should continue its opposition to PAS.

A minimalist legislative solution to the problem of euthanasia

Intense debate has continued for many years about whether voluntary euthanasia or assisted suicide should be permitted by law. The community is bitterly divided and there has been vigorous opposition from medical practitioners and the Australian Medical Association. Despite differences of religious and philosophical convictions and ethical values, there is widespread community agreement that people with terminal illnesses are entitled to adequate treatment, and should also be allowed to make basic choices about when and how they die. A problem with the current law is that doctors who follow current best practice cannot be confident that they will be protected from criminal prosecution. We propose simple changes to Commonwealth and state legislation that recognise community concerns and protect doctors acting in accordance with best current practice. This minimalist solution should be widely acceptable to the community, including both the medical profession and those who object to euthanasia for religious reasons. Important areas of disagreement will persist that can be addressed in future debates.

Closing the Schiavo case: an analysis of legal reasoning

The conflict surrounding Terri Schiavo, whom Florida's courts had determined wished not to be kept alive in a persistent vegetative state, played out on a national stage. The dispute between Schiavo's husband and parents engulfed America's legislative, executive, and judicial systems, raising profound questions about the laws and policies that govern advance directives. In this paper, we offer an analysis of the legal reasoning in Schiavo and offer predictions about the case's likely impact on law and policy in the future. We reviewed an extensive collection of case materials that included consensus definitions of persistent vegetative state, media reports, court decisions and briefs, legal chronologies, guardian reports, and Schiavo's autopsy report. We also reviewed cases cited as sources for legal reasoning used in Schiavo, including Quinlan, Cruzan, and Browning. We also examined the political, cultural, and media factors that affected the conflict. Based upon these reviews, we identified the legal reasoning that decided the Schiavo conflict. We found that Florida's constitutional right to privacy, a principle that shaped the Florida statutory and case law, guided the courts' consistent rulings. The conflict that characterized the case reflected profound differences in American politics rather than a failure of the medical and/or legal systems. The outcome of the Schiavo case remained consistent with established Florida statutory and case law, and honored Terri Schiavo's state constitutional right to privacy. Although Schiavo may not affect advance directive law and policy in palliative medicine immediately, evidence suggests it has already increased interest in creating living wills.

Euthanasia: an overview and the jewish perspective

BACKGROUND

End-of-life care poses fundamental ethical problems to clinicians. Defining euthanasia is a difficult and complex task, which causes confusion in its practical clinical application. Over the course of history, abuse of the term has led to medical atrocities. Familiarity with the relevant bioethical issues and the development of practical guidelines might improve clinical performance.

OBJECTIVE

To define philosophical concepts, to present historical events, to discuss the relevant attitudes in modern bioethics and law that may be helpful in elaborating practical guidelines for clinicians regarding euthanasia and end-of-life care. Concepts found in the classic sources of Jewish tradition might shed additional light on the issue and help clinicians in their decision-making process.

METHODS

An historical overview defines the concepts of active versus passive euthanasia, physician-assisted suicide and related terms. Positions found in classical Jewish literature are presented and analyzed with their later interpretations. The relevance and application in modern clinical medicine of both the general and Jewish approaches are discussed.

RESULTS

The overview of current bioethical concepts demonstrates the variety of approaches in western culture and legal systems. Philosophically and conceptually, there is a crucial distinction between active and passive euthanasia. The legitimacy of active euthanasia has been the subject of major controversy in recent times in various countries and religious traditions.

CONCLUSION

The historical overview and the literature review demonstrate the need to provide clearer definitions of the concepts relating to euthanasia, for in the past the term has led to major confusion and uncontrolled abuse. Bioethical topics should, therefore, be included in medical training and continuing education. There are major debates and controversies regarding the current clinical and legal approaches. We trust that classical Jewish sources might contribute to the establishment of clinical definitions, meaningful approaches and practical guidelines for clinicians.