In 2006 the University Hospital of Lausanne (CHUV) introduced an institutional directive specifying the conditions for assisted suicide, in accordance with professional guidelines and the recommendation of the Swiss National Advisory Commission on Biomedical Ethics that every acute care hospital take up a position on this subject. Methods: 18-months follow-up analysis of patient requests and application of the directive by hospital staff. Results: Of the 54000 patients hospitalised between January 1, 2006, and June 30, 2007, six requests were recorded, all within the first 7 months after introduction of the directive and in the context of severe and life-threatening diseases. However, only one of the six patients, living in a nursing home belonging to the hospital, died by assisted suicide. The time distribution of requests seems to be associated with initial media coverage of the assisted-suicide directive’s introduction.
Following advance directives in emergencies throws up some complicated problems, as Stephen Bonner and colleagues found. We asked an emergency doctor, a medical defence adviser, and an ethicist what they would do in the circumstances
Sir Terry Pratchett has said he's ready to be a test case for assisted suicide "tribunals" which could give people legal permission to end their lives. The author, who has Alzheimer's, says he wants a tribunal set up to help those with incurable diseases end their lives with help from doctors. A poll for BBC One's Panorama suggests most people support assisted suicide for someone who is terminally ill.
In this article, I consider whether the advance directive of a person in minimally conscious state ought to be adhered to when its prescriptions conflict with her current wishes. I argue that an advance directive can have moral significance after its issuer has succumbed to minimally conscious state. I also defend the view that the patient can still have a significant degree of autonomy. Consequently, I conclude that her advance directive ought not to be applied. Then I briefly assess whether considerations pertaining to respecting the patient's autonomy could still require obedience to the desire expressed in her advance directive and arrive at a negative answer.
Doctors will be allowed forcibly to sedate the 55-year-old woman in her home and take her to hospital for surgery. She could be forced to remain on a ward afterwards. The case has sparked an intense ethical and legal debate. Experts questioned whether lawyers and doctors should be able to override the wishes of patients and whether force was ever justified in providing medical care.
A cancer patient who has a phobia of hospitals should be forced to undergo a life-saving operation if necessary, a High Court judge has ruled. Sir Nicholas Wall, sitting at the Court of Protection, ruled doctors could forcibly sedate the 55-year-old woman - referred to as PS. PS lacked the capacity to make decisions about her health, he said. Doctors at her NHS Foundation trust had argued PS would die if her ovaries and fallopian tubes were not removed. Evidence presented to Sir Nicholas, head of the High Court Family Division, said PS was diagnosed with uterine cancer last year.
We aim to improve the medical care and understanding of disorders of consciousness following an acute insult such as coma, vegetative state, minimally conscious state or locked-in syndrome. Coma Science Group Cyclotron Research Center & Neurology Dept University of Liège
A majority of surveyed Flemish physicians appear to accept physician-assisted dying in children under certain circumstances and favour an amendment to the euthanasia law to include minors. The approach favoured is one of assessing decision-making capacity rather than setting arbitrary age limits. These stances, and their connection with actual end-of-life practices, may encourage policy-makers to develop guidelines for medical end-of-life practices in minors that address specific challenges arising in this patient group.
Medical end-of-life decisions are frequent in minors in Flanders, Belgium. Whereas parents were involved in most end-of-life decisions, the patients themselves were involved much less frequently, even when the ending of their lives was intended. At the time of decision making, patients were often comatose or the physicians deemed them incompetent or too young to be involved.
The 30-year-old, known only as SB, could die without emergency treatment for aplastic anemia, a condition in which her bone marrow does not reproduce enough new blood cells. The Court of Protection has now ruled that doctors can restrain SB and force her to undergo the arduous but potentially life-saving treatment, which is administered through a vein in the heart and lasts for five days. SB has been detained under the Mental Health Act. Family Division judge Mrs Justice Hogg ruled that the patient did not have the capacity to make up her own mind over whether to undergo the treatment.
A high court judge in England has ordered that doctors can force a woman without the capacity to decide for herself to have lifesaving treatment for aplastic anaemia. Mrs Justice Hogg made the ruling in the Court of Protection after an unnamed NHS trust applied to the court with the backing of the Official Solicitor, who looks after the interests of those lacking capacity. The judge said the 30 year old woman, named only as SB, who is detained under the Mental Health Act, has a serious psychiatric disorder and lacks the capacity to decide for herself whether or not to have the potentially lifesaving treatment.
A controversial court that still holds its hearing in private will decide tomorrow whether a pregnant woman with learning difficulties should be forcibly sterilised once she gives birth. Health workers from a local NHS trust and council, who cannot be named for legal reasons, have asked the secretive Court of Protection to decide whether the woman should be forced to have her fallopian tubes cut to stop her falling pregnant again.
Increasing understanding of the brain and associated advances in technologies to study it will enable improved treatment of neurodegenerative diseases & mental illnesses. But these advances will also increase our insights into normal human behaviour and mental wellbeing, as well as giving the possibility of other enhancement, manipulation, and even degradation of brain function. These developments are likely to provide significant benefits for society, and they will also raise major social and ethical issues due to wide ranging applications. Brain research is likely to have implications for a diverse range of public policy areas such as health, education, law, & security. More broadly progress in neuroscience is going to raise questions about personality, identity, responsibility, & liberty. Brain Waves explores the potential & the limitations of neuroscience insights for policymaking, as well as the benefits and the risks posed by applications of neuroscience and neurotechnologies.
Early in 2011, Illinois joined the ranks of states that recognize civil unions between both same-sex and opposite-sex couples. The law gives partners in these unions “the same legal obligations, responsibilities, protections and benefits as are afforded or recognized by the law of Illinois to spouses.” Despite the fact that Illinois and most other states still reserve marriage for opposite-sex couples, the option of civil unions will make it easier for some couples to make health care decisions for one another should one of them become incapacitated. Surrogate decision-makers for health care are a significant topic for everyone, but the issue has special resonance for same-sex couples because the law in most jurisdictions excludes same-sex couples from the benefits that marriage and some civil unions confer in those health care decisions. Timothy F. Murphy, "Surrogate Health Care Decisions and Same-Sex Relationships," Hastings Center Report 41, no. 3 (2011): 24-27.
A woman with "severe" anorexia who wanted to be allowed to die is to be force fed in her "best interests" by order of a High Court judge. Mr Justice Peter Jackson declared that the 32-year-old from Wales, who cannot be identified, did not have the capacity to make decisions for herself. He made public his judgment on Friday after making the ruling last month.
A lawyer who advised doctors that they must let a 22-year-old Jehovah's Witness die even though he wanted to live has spoken of the agonising scenes before the young man's death.
The family of a man left in a vegetative state after a heart attack has made an eleventh hour appeal for doctors to do all they can to keep him alive as they await a vital court ruling. Tomorrow, the court of protection in London will be asked to rule in a dispute over whether it is in "the best interests" of the severely brain-damaged man, who is from the Greater Manchester area, to continue to receive life-saving treatment if his condition deteriorates. Pennine Acute Hospitals NHS Trust claim it is not in the best interests to offer the man, known only as L, ventilation or resuscitation if his condition worsens and he suffers "a life-threatening event", such as another heart attack. But his family disagree and say they, not the trust, must be given the right to decide on his care.
A High Court judge has ruled in favour of an NHS trust that force feeding would not be in the "best interests" of an anorexic woman. Mrs Justice King, at the Court of Protection in London, heard that the 29-year-old woman, who weighs about 3st 2lb (20kg), does not wish to die. She ruled "all reasonable steps" should be taken to gain the woman's co-operation, without "physical force".
When your time comes to die, you probably hope that you will be surrounded by loving family members and friends who will support you and help you leave this earth at peace with one another. Sadly, for 28 year-old SungEun Grace Lee, who is dying in a Long Island hospital, Rather than suffer a slow, miserable death, Grace has requested that doctors take away the life support. After determining that she was mentally competent, doctors at North Shore University Hospital in Manhasset, N.Y., prepared to shut off her life support. But her parents did not agree.
Doctors have been given permission to perform potentially life-saving cancer surgery on a woman who has a "delusional belief" she does not have the disease. A judge at the Court of Protection in London ruled that the treatment would be lawful and in the best interests of the 61-year-old, who suffers from chronic schizophrenia.
A lady has cancer of the uterus. She could be cured by a potentially life-saving operation. However, because of other co-morbidities and other factors there is a considerable risk that she could die during the operation or in the post-operative recovery period. She herself lacks the capacity to make an informed decision, but she denies that she has cancer at all and opposes and is resistant to the operation. The medical team at the hospital consider that she would benefit from the operation and would like to perform it. The lady's three adult sons all strongly desire that she should have the operation and feel that the potential benefit outweighs the risk. The Official Solicitor, who acts as her litigation friend, considers, in a phrase, that it is too risky. The question for the court is whether, balancing all the relevant factors, it is in her overall best interests to have the operation or not.
Although DJ's condition is in many respects grim, I am not persuaded that treatment would be futile or overly burdensome, or that there is no prospect of recovery. (a) In DJ's case, the treatments in question cannot be said to be futile, based upon the evidence of their effect so far. (b) Nor can they be said to be futile in the sense that they could only return DJ to a quality of life that is not worth living. (c) Although the burdens of treatment are very great indeed, they have to be weighed against the benefits of a continued existence. (d) Nor can it be said that there is no prospect of recovery: recovery does not mean a return to full health, but the resumption of a quality of life that DJ would regard as worthwhile. The references, noted above, to a cure or a return to the former pleasures of life set the standard unduly high.
A pregnant woman with significant mental health impairments will not have to undergo an abortion after a senior judge ruled that she had enough capacity to decide whether she wanted to become a mother.
The landmark decision of Gillick v West Norfolk Area Health Authority was a victory for advocates of adolescent autonomy. It established a test by which the court could measure children's competence with a view to them authorising medical treatment. However, application of the test by clinicians reveals a number of ambiguities which are compounded by subsequent interpretation of Gillick in the law courts. What must be understood by minors in order for them to be deemed competent? At what point in the consent process should competence be assessed? Does competence confer on minors the authority to refuse as well as to accept medical treatment? These are questions which vex clinicians, minors and their families. A growing number of commentators favour application of parts of the Mental Capacity Act 2005 to minors. In this paper, the limitations of this approach are exposed and more radical reform is proposed.
Rechtsonzekerheid voor artsen bij uitvoering euthanasie onacceptabel Artsen houden zich goed aan de euthanasiewet, zo blijkt uit de tweede evaluatie van deze wet. Maar zij worden geconfronteerd met rechtsonzekerheid over het toetsingskader. Daarom steunt de KNMG de aanbeveling van een code of practice voor de toetsingscommissies en dringt zij aan op duidelijkheid over de waarde van de schriftelijke wilsverklaring bij wilsonbekwame patiënten. De KNMG reageert hiermee op de tweede evaluatie van de Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding (Wtl).
There is a considerable body of literature about the death penalty across a variety of disciplines. However, a newer body of literature has emerged examining the phenomenon of elected executions, also known as death row volunteering. To date, 138 (nearly 11%) of the 1300 death row executions have come from volunteers. This issue has been particularly controversial due to a number of legal and ethical considerations that have been raised by the scholarly, legal, and public communities. Such issues include a capital defendant’s competency to volunteer; ethical and moral dilemmas for capital defense attorneys, the states, and medical and mental health professionals; whether death row volunteering equates to ‘state-assisted suicide’; and finally, how these considerations impact the public’s support for capital punishment. This paper reviews the existing literature pertaining to death row volunteering through the lenses of these various considerations. Recommendations for future research in this area are also offered.
The first reported case of a British person choosing to end their own life at a centre in Switzerland because they had dementia has taken place. The 83-year-old was thought to be in the early stages of the neurodegenerative disease. A psychiatric assessment found that he was mentally competent to make the decision.
An international leader in bioethics, Peggy [Battin] explored the right to a good and easeful death by their own hand, if need be, for people who were terminally ill, as well as for those whose lives had become intolerable because of chronic illness, serious injury or extreme old age. She didn’t shy away from contentious words like “euthanasia.” In the weeks after the accident, Peggy found herself thinking about the title character in Tolstoy’s “Death of Ivan Ilyich,” who wondered, “What if my whole life has been wrong?” Her whole life had involved writing “wheelbarrows full” of books and articles championing self-determination in dying. And now here was her husband, a plugged-in mannequin in the I.C.U., the very embodiment of a right-to-die case study.
New report finds half of dying Britons are not dying well At a pivotal time for end of life care in Britain the need for advance care planning is reinforced Divided in Dying, a new report from charity Compassion in Dying, finds that almost half of those who have lost someone close to them through a short or long illness, feel their loved one died badly (45%). In cases where the dying person had recorded their end of life wishes, relatives and friends are more likely to report that they had a good death (58%). Alongside recording end of life wishes (19%), better communication between the doctor and their loved one (39%), co-ordination of care (33%) and being able to die in a place of their choice (31%) were also identified as key aspects which could have improved the situation for the person who died in a bad way. Compassion in Dying surveyed over 2400 British adults who were asked to recall the experience of the last relative or close friend who died.
The man’s lawyer stressed the case was not covered by the shadow of eugenics The Court of Protection could make legal history this month if it sanctions the sterilisation of a man with learning difficulties who lacks the ability to give permission.
Lord Falconer's Assisted Dying Bill [HL Bill 24] is the fourth of its kind to come before the House of Lords in the last ten years. None of its predecessors has made progress and the last one (Lord Joffe's Assisted Dying for the Terminally Ill Bill) was rejected in May 2006. This latest bill is little different from Lord Joffe's - it seeks to license doctors to supply lethal drugs to terminally ill patients to enable them to end their lives. The bill contains no safeguards, beyond stating eligibility criteria, to govern the assessment of requests for assisted suicide. It relegates important questions such as how mental capacity and clear and settled intent are to be established to codes of practice to be drawn up after an assisted suicide law has been approved by Parliament. This is wholly inadequate for a bill, such as this, with life-or-death consequences. Parliament cannot responsibly be asked to approve such a radical piece of legislation without seeing the nature of the safegua...
25th July 2013: The Mental Capacity Act (MCA) made Advance Decisions to refuse treatment legally binding in statutory law in 2005, and Compassion in Dying has been providing free information on end of life and Advance Decision forms since 2010. A new study, which looked at in excess of 200 calls to Compassion in Dying, found that a major barrier to patients exercising choice was doctors’ failure to engage with patients about their Advance Decision and the lack of systems in place to record them. Two callers reported considering a ‘DNR tattoo’ as a way of addressing this problem. The study also found women (84% of callers) are more likely than men (16%) to make their wishes known at the end of life. Professor Sue Wilkinson, author of the report and Professor of Feminist and Health Studies in the Department of Social Sciences at Loughborough University said: “This study has led to a number of recommendations for Compassion in Dying, and more broadly for the integration of Adva...
D. Coudert, N. Nepomuceno, and H. Rivano. 11èmes Rencontres Francophones sur les Aspects Algorithmiques de Télécommunications (AlgoTel'09), Carry le Rouet, (June 2009)
N. Anthapadmanabhan, A. Barg, and I. Dumer. (2006)cite arxiv:cs/0612073
Comment: final version, 12 pages, 2 figures, to appear in IEEE Trans. on
Inform. Theory - Special Issue on Information-theoretic Security, Jun 2008,
simplified proofs in Sections II and III, changes in Theorem 4.1.
M. Pappaioanou, M. Malison, K. Wilkins, B. Otto, R. Goodman, R. Churchill, M. White, and S. Thacker. Social science & medicine, 57 (10):
1925(11/15 2003)M3: Article; Accession Number: 10903681; Pappaioanou, Marguerite 1; Email Address: mxp1@cdc.gov Malison, Michael 2 Wilkins, Karen 3 Otto, Bradley 4 Goodman, Richard A. 5 Churchill, R. Elliott 6 White, Mark 7 Thacker, Stephen B. 8; Affiliation: 1: Office of Global Health, Mailstop D-69, 1600 Clifton Road, Atlanta, GA 30333, USA 2: Office of the Director, Public Health Practice Program Office, CDC, USA 3: Data for Decision-Making Project, Division of International Health, Epidemiology Program Office, CDC, USA 4: Indonesia Office, International Health Unit, MacFarlane Burnet Institute for Medical Research and Public Health Ltd., Indonesia 5: Division of Public Health Systems Development and Research, Public Health Practice Program Office, CDC, USA 6: Division of International Health, Epidemiology Program Office, CDC, USA 7: Division of International Health, EPO, CDC, USA 8: Epidemiology Program Office, CDC, USA; Source Info: Nov2003, Vol. 57 Issue 10, p1925; Subject Term: PUBLIC health; Subject Term: HEALTH; Subject Term: MEDICINE; Subject Term: MEXICO; Subject Term: PHILIPPINES; Subject Term: CAMEROON; Author-Supplied Keyword: Capacity building; Author-Supplied Keyword: Decision making; Author-Supplied Keyword: Epidemiology; Author-Supplied Keyword: Global health; Author-Supplied Keyword: Health information systems; Author-Supplied Keyword: Management; Author-Supplied Keyword: Public health policy; NAICS/Industry Codes: 525120 Health and Welfare Funds; Number of Pages: 13p; Document Type: Article.