Family decision making on trial: who decides for incompetent patients?

Article Abstract:

Decisions made by the highest courts in two states have made withholding of life-sustaining treatment more difficult. In these cases, the courts went against the prevailing medical, ethical, and legal consensus that families can make decisions about whether life is to be prolonged. Mary O'Connor suffered from dementia and was fed through a tube in her nose, in spite of earlier expressed wishes that she would not want to live if no longer capable of self-care. Nancy Cruzan, a 32-year-old, has been in a persistent vegetative state since a car accident in 1983 and had made statements that she would not want to live like a 'vegetable'. These cases raise important questions about the court's role in continuing life-sustaining care. Decisions are often not based on current clinical information, such as the realistic probabilities of recovery. Conflicts in testimony about the patient's responsiveness could be resolved by examining the patient at the time the decision is being made, rather than by examining witnesses. Specific 'advance directives' by the patient regarding life-sustaining treatment, which were required in the O'Connor case, can hardly be expected to correctly predict the type of disability that occurs. The risk also exists that a court may impose its own values on the patient's decision-making process. Court decisions that go against families' wishes imply that strangers are better judges of such things. In addition, there is a cruel contradiction built into the idea that families can decide to start a treatment such as tube feeding, but cannot decide to stop it. The best interests of incompetent patients are important concerns of the state, and should include considerations of dignity, dependence, and privacy. What about the quality of life for these people? By seeking to prevent inappropriate discontinuation of treatment, the Missouri ruling avoided discussing safeguards that might be instituted against such a development. The Supreme Court in the Cruzan case must decide whether people's constitutional rights to liberty and privacy outweigh the state's interest in preserving life. Courts, in fact, with their cumbersome, time-consuming procedures, may not be appropriate forums for resolving such issues. Family members should be allowed to decide these issues on the basis of the patient's wishes and best interests. Courts should only be involved when issues of bad faith are raised. Furthermore, where possible, physicians should discuss these matters with patients while the patients are healthy. Most elderly people concur with this recommendation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Evaluation, Laws, regulations and rules, Euthanasia, Informed consent (Medical law), Informed consent, Right to die, Bioethics, column

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Is it justifiable to withhold treatment for hepatitis C from illicit-drug users?

Article Abstract:

Doctors should offer to treat intravenous drug addicts with hepatitis C even if the patient is still using illicit drugs. Intravenous drug abuse is one of the ways hepatitis C is transmitted, so treating drug addicts is an important goal. However, the US National Institutes of Health in 1997 recommended withholding treatment from active drug users.

Care and treatment, Hepatitis C, Drug addicts, Drug abusers

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Conflict-of-interest policies for investigators in clinical trials

Article Abstract:

Many large research universities do not have strict conflict-of-interest policies governing faculty researchers. In a survey of 10 medical schools that receive the greatest amount of research funding, only four prohibited faculty members from owning stock or having a position in the company that would be affected by the results of the research.

Ethical aspects, Medical research

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