Legislating ethics: implications of New York's Do-Not-Resuscitate law

Article Abstract:

Many hospitals have maintained policies, either formal or informal, regarding the resuscitation of chronically ill patients. Most recognize the patient's right to refuse treatment, but problems arise when the patient cannot make such a decision. Most commonly, the patient cannot make the decision because he/she is in need of resuscitation when the decision must be made. In 1987, New York became the first state to pass a law governing the issue of Do-not-resuscitate (DNR) orders by the physician. While some people complain of cumbersome requirements, the law did little more than codify procedures which were essentially in place already. By law, a physician must obtain a patient's consent before two witnesses prior to issuing a DNR order. If the patient is incapable of giving informed consent, the attending physician and one concurring physician must give a written statement of the patient's condition and prognosis to the patient and a legal guardian or next of kin. This surrogate may consent to a DNR order if the patient's condition is terminal, if the patient is irreversibly comatose, or if the resuscitation is futile or would impose some extraordinary hardship. Although the law requires that a patient be advised of the right to request DNR orders, studies show that fewer than 28 percent of patients actually get involved personally; the majority of such decisions are still made by surrogates. Some physicians feel that the complications of the procedure often prevent the making of what they consider to be common sense decisions; the net result is that people are resuscitated when no one thinks it is appropriate, simply because no DNR order is on record. The Patient Self-Determination Act of 1989, introduced before the Senate, is perhaps a step in the right direction. The Act requires the formation of hospital ethics committees, but does not require specific procedures. In essence, the Act sets standards for ethical concerns such as the DNR order, but does not specify the means by which individual hospitals might decide to meet these standards. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical care, Hospitalization, Medical ethics, Hospital care, Medical law, Resuscitation

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Physicians' aid in dying

Article Abstract:

In November 1991, residents of Washington State will vote on Initiative 119, which permits physicians to legally assist in the death of mentally competent and terminally ill patients. Regardless of how any individual physician might feel about euthanasia, the proponents of the bill have done a service by bringing the topic into public debate. The right of a patient to refuse treatment, even when this would mean his death, is well established. Furthermore, physicians have often withheld treatment that would only serve to prolong incurable illness. However, many people feel that withholding treatment is fundamentally different from taking an action that would end life. There are many facets of euthanasia, and a survey of important questions is presented. For example, would the legalization of euthanasia make some terminally ill patients feel compelled to die to avoid prolonging the expense and hardship for their families? Conversely, might the option of euthanasia compel physicians to provide better care for the terminally ill patient so he does not take the option? Some argue that permitting euthanasia, even for patients in great pain, would represent an erosion of respect for life, which may then result in abuses. It seems clear that individual physicians who do not condone euthanasia would be put into the uncomfortable position of seeing some patients travel to another state in search of a physician who does, and who will help them end their life. For many religions, taking a life cannot be condoned under any circumstances. However, some religions will condone treatment that shortens life, provided the purpose of the treatment is good. For example, high-doses of morphine may shorten a patient's life, but may be given if needed to alleviate pain. Some believe that the view of any particular religion should not guide the decisions of lawmakers. These and other questions need to be addressed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Euthanasia

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Rational suicide and the right to die: reality and myth

Article Abstract:

Discussion over the rights of patients to end their own lives has gone on for many years. In 1990, public discussion of the right to commit suicide was rekindled by the help received by Janet Adkins from her doctor when she decided that a dignified death was preferable to deteriorating from the effects of Alzheimer's disease. Her docter, Jack Kevorkian, was charged with murder for equipping her with a suicide machine, but charges were dropped, since Michigan had no specific law against assisting suicide. It seems reasonable to assume that assisted suicides are far more numerous than the cases that reach the news media. The term 'rational suicide' has been used to describe suicide that is carefully considered as an alternative to an incurable ailment. However, little discussion takes place about the conditions under which suicide can actually be considered rational.

Editorial

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