Euthanasia - a critique

Article Abstract:

Euthanasia (literally, a 'good death') refers to the assisted death of terminally ill patients at the hands of another person. Three recent developments indicate that public awareness is focusing on this issue: a recently published first-person account of euthanasia, an attempted legislative initiative to permit euthanasia in California, and permission for doctors in the Netherlands to aid suffering patients in this manner if certain stringent criteria are met. Physicians in this country, however, are urged to reject arguments favoring euthanasia, which is defined as the "deliberate action by a physician to terminate the life of a patient". This is distinguished from several other kinds of situations a physician may face, including withholding life-supporting treatment; administration of analgesics for pain relief; 'assisted suicide', in which a doctor prescribes lethal drugs, but does not administer them; and 'mercy killing' by a patient's family or friends. Supporters of euthanasia believe doctors should terminate the lives of willing patients who are in extreme pain. People should not have to end their lives hooked up to modern life-sustaining equipment. According to this view, the individual has the right to determine his or her own medical care, including physician-administered death. However, such individual interests must be weighed against the public good. Arguments against euthanasia are based on its dangers if made part of public policy, and its violation of the ethical norms of medicine. If euthanasia became part of public policy, it could be performed on people against their wishes. The ways this could happen are described, some of which are unique to the United States and not applicable to a country such as Holland. Euthanasia is a profound violation of medical norms and undermines the basic definition of the term 'physician'. To resist pressure toward euthanasia, physicians need to respond more to dying patients' needs and to offer them the pain management they need. In the ultimate case, if euthanasia were to be legalized, physicians should refuse to practice it. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules, Public opinion, Euthanasia, Medical ethics, editorial

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Beyond autonomy - physicians' refusal to use life-prolonging extracorporeal membrane oxygenation

Article Abstract:

Physicians should have no legal obligation to provide treatment that they believe is ineffective or against the best interests of the patient. These treatments are sometimes demanded by patients or their families. In one case, a five-year-old boy fell two stories, was hospitalized and placed on a ventilator. When ventilation was unsuccessful, he was placed on a heart- and lung-bypass machine so his lungs could recuperate. This never happened, and the doctors decided to remove him from the machine. The parents protested and threatened legal action. However, the hospital attorney and an ethics committee backed the physicians' right to discontinue a treatment that was obviously ineffective. The parents ultimately agreed and the boy was removed from the machine. He died immediately. This case illustrates that the physician's decisions should be based on what is best for the patient. However, patients and their families should still be partners in medical decision-making.

Column, Terminal care, Medical care decision-making authority (Law), Medical care decision making authority (Law), Life support systems (Critical care), Life support care

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Informed consent in emergency research: prehospital thrombolytic therapy for acute myocardial infarction

Article Abstract:

The problem of informed emergency consent is examined, using a pilot study of prehospital thrombolytic therapy for myocardial infarction. Federal regulations do not provide clear guidelines for emergency research on conscious patients. Researchers currently approach emergency consent in four ways: by avoiding such research, by omitting the consent process, by obtaining consent after the fact, or by obtaining consent as in non-emergency research. A fifth approach, two-step consent, is suggested, which would permit emergency research while protecting the rights of the patients. In a two-step process, consent is first obtained for prehospital treatment, then consent to continuation of the program of treatment is obtained at the hospital. Such a process could be an alternative solution for future studies in emergency medicine.

Research, Analysis, Prevention, Heart attack, Dosage and administration, Informed consent (Medical law), Informed consent, Fibrinolytic agents, Medical protocols, Infarction, Thrombolytic drugs, Emergency medicine

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