Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-09T14:22:08.216Z Has data issue: false hasContentIssue false
  • English
  • Français

Is There a Lingua Franca for Bioethics at the End of Life?

Published online by Cambridge University Press:  01 January 2021

Arthur R. Derse
Get access Rights & Permissions [Opens in a new window]

Extract

In this issue, Raphael Cohen-Almagor reviews some of the terms used in the discussion of bioethical issues at the end of a patient's life; he argues that they are “valueladen” and serve “primarily the physicians, at times at the expense of the patients’ best interest.” Each of the following terms comes under scrutiny: “death with dignity,” “persistent vegetative state,” “futility,” “double effect,” and “brain death.” He argues that these concepts, developed in recent decades, “have generated an unhealthy atmosphere for patients, which might lead to undesirable actions at the end of patients’ lives.” He issues a plea to discontinue the use of the term “persistent vegetative state” because it is dehumanizing, to explain “double effect” and “futility” in detail and with sincerity, and to clarify the motivation for using these terms and others. He warns physicians not to use terminology that is offensive to patients and loved ones or that weakens their patients’ will to live.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 28 , Issue 3 , Fall 2000 , pp. 279 - 284
Copyright
Copyright © American Society of Law, Medicine and Ethics 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. R. Cohen-Almagor, “Language and Reality at the End of Life,” Journal of law, Medicine & Ethics, 28 (2000): 267-278, at 267.CrossRefGoogle Scholar

2. Id.Google Scholar

3. Id., at 275.Google Scholar

4. Id.Google Scholar

5. Id.Google Scholar

6. Id., at 274-5..Google Scholar

7. Webster's Collegiate Dictionary, 9th ed. (Springfield, Massachusetts: Merriam Webster, 1983): at 695.Google Scholar

8. C.E. Schneider, “Bioethics in the Language of the Law,” Hustings Center Report, 24, no. 4 (1994): 16-22.CrossRefGoogle Scholar

9. W.P. Keeton et al., Prosser and Keeton on Torts, 5th ed. (St. Paul, Minnesota: West Publishing Company, 1984).Google Scholar

10. WJ. Donnelly, “The Language of Medical Case Histories,” Annals of lnternal Medicine, 127 (1997): 1045-1048.CrossRefGoogle Scholar

11. A. Meisel, “The Legal Consensus about Forgoing Life- Sustaining Treatment: Its Status and Prospects,” Kennedy Institute Of Ethics Journal, 2 (1993): 309-345.CrossRefGoogle Scholar

12. Cohen-Almagor, supra note 1, at 275.Google Scholar

13. A.R. Derse, “Legal Issues in End-of-life Care,” in L.L. Emanuel, C.F. von Gunten, and ED. Ferris, eds., Education for Physicians on End-of-life Care (EPEC) Curriculum, Robert Wood Johnson Foundation (Chicago: American Medical Association, 1999): 2-8.Google Scholar

14. P.R. Helft, M. Siegler, and J. Lantos, “The Rise and Fall of the Futility Movement,” N. Engl. J. Med., 343 (2000): 293-295.Google Scholar

15. S.B. Rubin, When Doctors Say No : The Battleground of Medical Futility (Bloomington, Indiana: Indiana University Press, 1998).Google Scholar

16. J.R. Curtis et al., “Use of the Medical Futility Rationale in Do-Not-Attempt-Resuscitation Orders,” JAMA, 273, no. 2 (1995): 124-128 (see comments).CrossRefGoogle Scholar

17. J.D. Lantos et al., “The Illusion of Futility in Clinical Practice,” American Journal of Medicine (1989): 878 1-8784.CrossRefGoogle Scholar

18. Derse, supra note 13, at 2-9.Google Scholar

19. M.D. Cantor, C. Braddock, A.R. Derse et al., Do-Not- Resuscitate Orders and Medical Futility. A Report by the National Ethics Committee of the Veterans Health Administration (Washington, D.C.: National Center for Ethics, Veterans Health Administration, Department of Veterans Affairs, September 2000).Google Scholar

20. Cohen-Almagor, supra note 1, at 270.Google Scholar

21. Futility and rationing differ. See N.S. Jecker and L.J. Schneiderman, “Futility and Rationing,” American Journal of Medicine, 92 (1992): 189-196.CrossRefGoogle Scholar

22. Cohen-Almagor, supra note 1, at 271.Google Scholar

23. N.A. Christakis, Death Foretold: Prophecy and Prognosis in Medical Care (Chicago: University of Chicago, 1999).Google Scholar

24. G.J. Annas, “Informed Consent, Cancer, and Truth in Prognosis,” N. Engl. J. Med., 330 (1994): 223-225.CrossRefGoogle Scholar

25. Cohen-Almagor, supra note 1, at 271.Google Scholar

26. Id., at 268.Google Scholar

27. In re Guardianship of LW, 167 Wis. 2d 53 (1992).Google Scholar

28. “Physician Assisted Suicide,” Module 5, in L.L. Emanuel, C.F. von Gunten, F.D. Ferris, eds., Education for Physicians on End-of-Life Care (EPEC) Curriculum, Robert Wood Johnson Foundation (Chicago: American Medical Association, 1999): M5-12.Google Scholar

29. A.E. Chin et al., “Legalized PAS in Oregon-The First Year's Experience,” N. Engl.]. Med., 340 (1999): 577-83.Google Scholar

30. D.P. Sulmasy and E.D. Pellegrino, “The Rule of Double Effect: Clearing Up the Double Talk,” Archives of lnternal Medicine, 159 (1999): 545-550.CrossRefGoogle Scholar

31. Cohen-Almagor, supra note 1, at 272.Google Scholar

32. Derse, supra note 13, at 2-8.Google Scholar

33. Vacco v. Quill, 117 S. Ct. 2293 (1997).Google Scholar

34. T.E. Quill and D.W Brock, “Palliative Options of Last Resort: A Comparison of Voluntarily Stopping Eating and Drinking, Terminal Sedation, Physician-Assisted Suicide, and Voluntary Active Euthanasia,” JAMA, 278 (1997): 2099-2104.CrossRefGoogle Scholar

35. S.J. Youngner and D.T. Bartlett, “Human Death and High Technology: The Failure of Whole-Brain Death Formulations,” Annals of lnternal Medicine, 99 (1983): 252-258.Google Scholar

36. New Jersey Declaration of Death Act, N.J. Stat. Ann. tit. 26 𝕤 6A-1 to 6A-8 (West 1991); N.Y. Comp. Codes R. & Regs. tit. 10 𝕤 400.16(e)(3) (McKinney 1987). There are some practical problems worthy of a law school examination question that can result from the lack of uniformity in definitions of brain death. For instance, if a Pennsylvania resident who was a member of a religious community that did not recognize brain death met the criteria for brain death and was declared dead in Pennsylvania and then transported while still dependent upon a ventilator from Pennsylvania to New Jersey, would the patient be considered dead or alive?Google Scholar

37. Cohen-Almagor, supra note 1, at 273.Google Scholar

38. Id, at 269.Google Scholar

39. Webster's Collegiate Dictionary, supra note 7, at 1307.Google Scholar

40. R.E. Cranford, “The Persistent Vegetative State: The Medical Reality (Getting the Facts Straight),” Hastings Center Report,18 (1988): 27-32.CrossRefGoogle Scholar

41. Council on Scientific Affairs and Council on Ethical and Judicial Affairs, American Medical Association, “Persistent Vegetative State and the Decision to Withdraw or Withhold Life Support,” JAMA, 263 (1990): 426-430.CrossRefGoogle Scholar

42. New York State Task Force on Life and the Law, When Others Must Choose: Deciding for Patients Wthout Capacity (Albany Health Research Inc., March 1992). Tracy Miller, the founding executive director of the task force, said that the task force chose to use permanent unconsciousness because the members concluded it was more respectful of patients than persistent vegetative state (personal communication, October 12,2000).Google Scholar

43. Cruzan v. Missouri Department of Health, 497 U.S. 261 (1990)Google Scholar