Searching for Answers in the Garden of Bioethics

SSRN Electronic Journal, 2017

As a field, bioethics purports to provide a culturally-neutral methodology to assess ethical implications in care of human life. In America, this is "based on four common, basic prima facie moral commitments-respect for autonomy, beneficence, nonmaleficence, and justice". 1 Based on that assumption, we would expect that similar ethical dilemmas in the same loci would generate similar outcomes. Similarly we would expect that exactly the same dilemmas in different loci with similar cultures would also result in the same outcome. Nothing could be farther from the truth. This case-study illustrates two scenarios: the first concerns the State of Texas whose legislature simultaneously empowers doctors to "withhold or withdraw lifesustaining treatment (upon approval of the medical ethics committee), if, in the doctors' judgment continued care and feeding would not prolong the patient's life," and restricts a woman's right to abortion. The statutes, as they are effectuated serve to deprive the living lucid of a right to life, while affording the unborn fetus superior status in protecting that entities' existence, even at the expense of the woman carrying it. The second scenario is situation-driven. Here we have one court in the United States determining a seventeen year old may not refuse treatment to end her life. In the Netherlands, the outcome was entirely different. Christopher Dunn versus the State of Texas 2 In November of 2015, David Christopher Dunn, 3 age 46, was admitted to Houston Methodist Hospital with a questionable diagnosis of a life-threatening condition. 4 Regardless, he was lucid and coherent, 5 although because of breathing and feeding

Theoretical Medicine and Bioethics, 2015

Internal Medicine Journal, 2019

While the traditional model of consent is supported by codes and theories of ethics, is enshrined in law, and provides the core of health policy and clinical governance, it is unclear how accurately it reflects clinical practice and in particular how accurately it accounts for edition-making in 'high-risk' situations where patients are critically ill and facing death. Main text In Western liberal democracies, the requirement for a patient's informed consent prior to medical treatment is indisputable. The importance attached to consent reflects the cultural and philosophical privileging of autonomy, liberty, and human rights and the broad commitment to the recognition and maintenance of human dignity. For a patient's consent to be legally and ethically valid, it is generally assumed that a number of 'criteria' or 'elements' need to be satisfied, namely that the patient has the capacity to consent, has made the decision voluntarily, and has been provided with 'material' information about the proposed treatment, including its rationale, costs, risks and benefits. While differences remain between patient-centred and doctor-centred approaches to standards of information provision, it is clear that all common law countries demand that patients be told of the risks of having, or not having, treatment. But while this traditional model of consent is supported by codes and theories of ethics, is enshrined in health law, and provides the core of health policy and clinical governance, it is unclear how accurately it reflects clinical practice, and in particular, how accurately it accounts for decision-making in 'high-risk' situations where patients are critically ill and facing death.

Health, Law and Policy, 2008

There are few issues more divisive than what has become known as ""the right to die."" One camp upholds ""death with dignity,"" regarding the terminally ill as autonomous beings capable of forming their own judgment on the timing and process of dying. The other camp advocates ""sanctity of life,"" regarding life as intrinsically valuable, and that should be sustained as long as possible. Is there a right answer? Raphael Cohen-Almagor takes a balanced approach in analyzing this emotionally charged debate, viewing the dispute from public policy and international perspectives. He offers an interdisciplinary, compelling study in medicine, law, religion, and ethics. It is a comprehensive look at the troubling question of whether physician-assisted suicide should be allowed. Cohen-Almagor delineates a distinction between active and passive euthanasia and discusses legal measures that have been invoked in the United States and abroad. He outlines reasons non-blood relatives should be given a role in deciding a patient's last wishes. As he examines euthanasia policies in the Netherlands and the 1994 Oregon Death with Dignity Act, the author suggests amendments and finally makes a circumscribed plea for voluntary physician-assisted suicide.

Theoretical Medicine and Bioethics, 2000

Bioethics, and indeed much ethical writing generally, makes its point through narratives. The religious parable no less than the medical teaching case uses a simple story to describe appropriate action or the application of a critical principle. While powerful, the telling story has limits. In this paper the authors describe a simple teaching case on "end-of-life" decision making that was ill received by its audience. The authors ill-received example, involving the disconnection of ventilation in a patient with ALS (Lou Gherig's Disease) was critiqued by audience members with long-term experience as ventilation users. In this case, the supposedly simple narrative of the presenters conflicted with the life histories of the audience. The lessons of this story, and the conflict that resulted, speak critically to the limits of simple teaching cases as well as the strengths of narrative analysis as a tool for the exploration of bioethical case histories.

Journal of Bioethical Inquiry, 2008

Conflicts between bioethicists and disability theorists often arise over the permissibility of euthanasia and physician assisted suicide. Where mainstream bioethicists propose universalist guidelines that will direct action across a range of effectively disembodied situations, and take for granted that moral agency requires autonomy, feminist bioethicists demand a contextualisation of the circumstances under which moral decision making is conducted, and stress a more relational view of autonomy that does not require strict standards of independent agency. Nonetheless, neither traditional nor feminist perspectives have fully engaged with the critique of disabled people that they are consistently subjected to discriminatory, even life-threatening, practice and policy in biomedical and health care. The paper revisits some of the issues that drive the often highly polarised debate between bioethicists and disability theorists around the question of end of life decisions involving disabled people. While many bioethicists have doubtless been indifferent to the difference that disability makes, I am also concerned that the very proper demand of disability activists and theorists to scrutinise all end of life decisions for signs of discrimination and even violence has segued into something damagingly restrictive that silences inter-nal dissension and stifles external debate. Given that euthanasia and physician assisted suicide may be issues where conventional argument on either side will founder on deeply felt convictions, I make the radical move to speculate on an entirely different, quasi-Deleuzian, approach to the value of life in order to shake up entrenched positions, and begin to think differently.

2019

A culture of dying characterized by end-of-life care provided by strangers in institutional settings and diminished personal control of the dying process has been a catalyst for the increasing prevalence of legalized physician-assisted dying in the United States and medically-assisted dying in Canada. The moral logic of the right to die that supports patient refusals of life-extending medical treatments has been expanded by some scholarly arguments to provide ethical legitimation for hastening patient deaths either through physician-prescribed medications or direct physician administration of a lethal medication. The concept of medical-assisted dying increases the role and power of physicians in ending life and allows patients who are not terminally ill, or who have lost decision-making capacity, or who are suffering from a irremediable medical condition to have access to medical procedures to hasten death. This extended moral logic can be countered by ethical objections regarding t...

HEC Forum, 2004

2014

There is some presupposition of the exclusion of death as a right from the human rights jurisprudence. The purpose of this work is to establish that everyone has an inherent “right to suicide” and can validly exercise this right where legitimate conditions for its exercise arise. Suicide in this work covers three forms of consensual killing: suicide, mercy killing by family and physician assisted death. This work advocates the recognition of the authority of family and other persons including physicians to assist or take other positive steps towards facilitating the death of a terminally ill person in endless pains with (or without) the consent of the person involved especially cases involving infants, persons with diminished mental capacities and other categories of persons with deficient competence and rationality to determine what is best in relation to certain medical conditions.