The health care proxy and the living will

Article Abstract:

On December 1, 1991, all hospitals, nursing homes, hospices, and health maintenance organizations serving Medicare or Medicaid patients will be required to provide new adult patients with written information describing patients' rights to make decisions about medical care. Patients have the right to refuse any medical interventions, even those to sustain life, and it is hoped that the new forms will improve communication between patients and their doctors. More than 40 states have ''living will'' statutes, but almost all of them have four important shortcomings. First, they apply only to the ''terminally ill''; the types of treatment that can be refused are limited to ''artificial'' or ''extraordinary'' means; there is no provision for the designation of another person to make decision on the patient's behalf; and fourth, there is no penalty if health care providers ignore the patient's wishes. Other drawbacks are also cited. Every state has a durable-power-of-attorney law that permits a person to designate another to make decisions in the event the person is incapacitated, and this has led to the designation of health care proxies. This should help to simplify decision-making, and make it more likely the patient's wishes will be honored. It should also make it easier for the physician, who can discuss treatment with a single designated person. The structure and limits of the document are discussed, and a health care proxy based on Massachusetts law is provided in the appendix. To be useful, the form must be written in plain English, and should not require a lawyer to interpret. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Evaluation, Physician and patient, Physician-patient relations, Living wills, editorial

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The health of the president and presidential candidates: the public's right to know

Article Abstract:

The public should have limited access to the details of a president's or presidential candidate's medical records. Presidential candidates themselves should set reasonable limits on how much of their health is revealed to the public. The 25th Amendment to the Constitution determines the processes that should be followed when a president is disabled. Ultimately an executive or Congressionally-appointed board, not a physician, may declare a president unable to perform his duties. As with all physicians, those who care for the president or candidates have an ethical responsibility to maintain the patient's privacy. However, the public should be informed when the president becomes ill or injured. Disclosure of all of a president's medical records may have the adverse effect of discouraging presidents from seeking needed medical advice.

Health aspects, Presidents, Presidents (Government), Presidential candidates

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Partial-birth abortion, Congress, and the Constitution

Article Abstract:

Medical associations like the American Medical Association (AMA) should take a firm stand against government intrusion into medical decisions. The proposed ban on partial-birth abortions is one such intrusion. In a partial-birth abortion, the fetus is partially delivered before being killed. A bill banning this practice has been introduced twice in Congress and vetoed both times by Pres Clinton. The AMA supported the ban, which seems to be a complete reversal of its historic position against governmental interference in the practice of medicine.

Laws, regulations and rules, Political activity, American Medical Association, Abortion

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