The Case of Vincent Lambert and the Role of 'Dissensus'
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The Withdrawal of Treatment
The Withdrawal of Treatment Lucy Elisabeth James Abstract The withdrawal of treatment is one of the most emotionally challenging and ethically complex aspects of end-of-life care. As our ability to prolong life progresses, the necessity to address issues such as the withdrawal of treatment increases in parallel. This paper approaches the subject from an ethical point of view and aims to establish the utility of ethical frameworks in the 21st century. To achieve this, the withdrawal of treatment is outlined and the arguments both for and against this topic are considered. Ethical frameworks are summarised and applied to the Airedale NHS Trust v. Bland [1993] case. The article argues that through asking ethical questions, one seems not to shed light on the matter, but only emphasises its complexity. In conclusion, although a traditional ethical framework may be applied to the issue of the withdrawal of treatment, multiple criticisms accentuate its impracticality and irrelevance in the modern medical world. Introduction be performed for the benefit of others, Ethical frameworks will be studied, and In my first year of University a close friend thus all healthcare providers must strive are applied to the Airedale NHS Trust v. of mine was involved in a critical accident. to do the most good for the patient. Bland [1993] case study. He remained on life support for the Non-maleficence is one of the principal following six months before physicians precepts of medical ethics and involves decided that the most appropriate action The withdrawal of treatment healthcare providers avoiding causing to take would be to withdraw support. -
A Right to Die: a Comparing Discourse of Case Laws in United States of America, European Court of Human Rights, United Kingdom and Albania
JAHR Vol. 5 No. 9 2014 UDK 34:17:614.253 Professional article Brunilda Bara, Gentian Vyshka* A right to die: a comparing discourse of case laws in united states of america, european court of human rights, united kingdom and albania ABSTRACT As human beings we are bound up with the medical profession. It is certain that at some point in our life we rely on their help. Even if such help is avoided throughout life, some life activities involve recourse to medical care. During the exercise of its activity the medical profession is faced with many ethical dilemmas, where the solution is not in the law, where choice and decision making become difficult in terms of ethics and where they must rely on their values and judgments. That’s why the involvement of the medical profession in everyone’s lives makes the understanding of the law governing the medical profession extremely important. Patient rights are part of human rights. This article’s aim is to present one important patient right - the right to die. Whilst is accepted the increasing role of the medical profession in determining the shape of the law in medical care, this article focuses on understanding how different courts deal with cases involving the right to die. The article offers a framework on patient’s right to die in the United States of America, Europe, United Kingdom and Albania. Key words: assisted suicide, case law, euthanasia, right to die, right to life, physician * Correspondence address: Gentian Vyshka, Faculty of Medicine, University of Tirana, Albania, e-mail: gvyshka@ yahoo.com 135 JAHR Vol. -
FEBRUARY 2020 Vol
The Journal of the IYNA INS Edition FEBRUARY 2020 Vol. 3 Issue 2 Featured Articles ‘Ethical Implications ‘Neuromarketing in ‘Nico-teen: The for Electrostimulation Politics: The Ethics of Neuroethics of Ado- and Optogenetics’ a New Age’ lescent Electronic - Dyanne Ahn - Aybala Turkarslan Cigarette Use’ - Jaeah Kim International Youth Neuroscience Association 1 Contents INTRODUCTION Letter from the Editors IYNA Editorial Team page 3 ARTICLES Armstrong? More like Brainstrong: Cognition Kyle Sugita page 4-6 Enhancing Drugs in Academia BCIs – Increasing the Wealth Gap Kalie Uberti page 7-9 Brain-Computer Interfaces: Futuristic Prospects Athena Yao page 10-13 and Ethical Dilemmas Ethical Implications for Electrostimulation and Dyanne Ahn page 14-17 Optogenetics Moving On: A Refugee Crisis Lasya Kambhampati page 18-21 Neuromarketing in Politics: The Ethics of a New Aybala Turkarslan page 22-26 Age Nico-teen: The Neuroethics of Adolescent Jaeah Kim page 27-31 Electronic Cigarette Use Stuck in Modern Limbo: How Can We Help the Milena Malcharek page 32-35 (Un)Conscious Patients? The Problem with Propranolol: Implications of Mustakim Muhurto page 36-38 Memory Dampening Technology Rahman The Rising Conflict Between Neuroscience and Nannarelle page 39-42 Who We Are Hundertmark 2 Treating Unconscious Patients When Sonia Seth page 43-46 End-of-Life Preferences Are Not Declared Who Do We Believe?: The Neuroethics Lauren Kayari page 47-49 Surrounding the #MeToo Movement CONTRIBUTORS PAGE page 50 3 Letter From the Editors Sojas Wagle , Anita Singh, and Anushka Sarda Dear Readers, Welcome to the special INS (International Neuroethics Society) issue of the IYNA Journal! We greatly appreciate your readership, continued or new. -
A Beacon of Light
12 life&hope | lifeandhope.com A Life That Matters: The Legacy of Terri Schiavo Paperback, $14.99 on Amazon.com n marking the fourteen–year anniversa- alive in their imaginations in particular.” ry of the release of “A Life That Matters: TheI Legacy of Terri Schiavo,” co-author New, paperback copies can be ordered Bobby Schindler is excited to announce 24/7 on Amazon.com, by searching for the book’s permanent paperback availabil- “A Life That Matters: The Legacy of Terri ity through Amazon.com. S c h i a v o .” “I wrote the story of my sister’s fight along “I’m always interested in hearing reactions — Annual Report of the& Terri Schiavo Life & Hope Network with my family in the weeks and months and especially questions — from readers. life hope following Terri’s death. This book is one I invite anyone to reach out to me anytime 2020 Edition | lifeandhope.com way I hope Terri’s life and witness can by emailing me at bschindler@lifeandhope. continue to positively impact lives. Young com. I’m grateful and hopeful that this people, in particular, didn’t experience my book can be a gift for people, especially family’s fight and my sister’s witness first- within the pro-life community, to under- hand. For so many of the youngest people stand someone whose name has become I speak to, Terri’s story is simply a history an indelible part of American history.” lesson. This book is a way to bring her Fake News: Media Still Paints Judge Who Ordered Terri Schiavo’s Death as the Victim Continued from page 5… A Beacon of Light agenda to the extent that it is now com- been), it was only a matter of time until no longer met the prevailing societal status mon practice to starve and dehydrate the the cognitively disabled were labeled as for personhood, so how dare his parents The Terri Schiavo Life & Hope Network joins Catholic Healthcare International's effort medically vulnerable in all fifty states as incapable of possessing moral equivalency. -
Analyzing the Paradigmatic Cases of Two Persons
Picozzi et al. BMC Med Ethics (2021) 22:88 https://doi.org/10.1186/s12910-021-00656-w RESEARCH ARTICLE Open Access Analyzing the paradigmatic cases of two persons with a disorder of consciousness: refections on the legal and ethical perspectives Mario Picozzi1,2* , Lino Panzeri3, Davide Torri4 and Davide Sattin2,5 Abstract Background: Media have increasingly reported on the difculties associated with end-of-life decision-making in patients with Disorders of Consciousness (DOC), contextualizing such dilemma in detailed accounts of the patient’s life. Two of the frst stories debated in the scientifc community were those related to the cases of two women, one American, the other Italian, who captured attention of millions of people in the frst years of this third millennium. Methods: Much has been written about the challenges of surrogate decision-making for patients in DOC, but less has been written comparing these challenges across legal systems and cultures. In our paper, we propose a sys- tematic analysis of the fnal legal documents written by the American and Italian Courts in relation to the two cases, developing our discussion around three areas: the level of certainty/reliability of diagnosis and prognosis, the recon- struction of self-expression, time of illness and time of care. They are examples of the typical issues discussed by legal authors and allow us to understand the link and the diference between the legal and ethical perspectives. Results: The legal approach to the two cases has some common elements: the need to be certain about the diagno- sis and prognosis and the fact that the clinical criteria are necessary in determining the most appropriate treatments, although these criteria are not sufcient unless they are supplemented by the patient’s will. -
The Withdrawal of Tube-Assisted Nutrition and Hydration from Patients in Permanent Vegetative and Minimally Conscious States
10.9.19 Position Statement on: The withdrawal of tube-assisted nutrition and hydration from patients in permanent vegetative and minimally conscious states The Scottish Council on Human Bioethics (SCHB) has grave concerns about medical decisions to withdraw or withhold tube-assisted nutrition and hydration in patients who are in Permanent Vegetative States (PVS) and Minimally Conscious States (MCS) as this requires the intentional ending of human life. These patients have profound brain injuries, but their death is not imminent. They are human persons with all the rights that the UK Human Rights Act 1998 confers. Although a feeding tube is inserted in hospital, nutrition and hydration is usually given by family members in the home or carers or nurses in a nursing home setting. If the carer or family member were to stop nutrition and hydration because they felt it was not in the interests of their loved one, there would rightly be concern and a criminal prosecution would be likely. This statement and following paper will delineate the ethical risks surrounding medical decisions to stop tube-assisted nutrition and hydration in patients with PVS and MCS. 1.The withdrawal or withholding of tube-assisted nutrition and hydration, when death is imminent and feeding is futile, is acceptable. The withdrawal or withholding of tube-assisted nutrition and hydration in a dying patient whose death is both imminent and inevitable may be acceptable. It is good medical practice to do so if the burden to the patient of the procedure outweighs its benefit, and the intention is to relieve suffering rather than to hasten death. -
European Court of Human Rights (Gc), Case of Lambert and Others V
Comparative Law Review 21 2016 Nicolaus Copernicus University http://dx.doi.org/10.12775/CLR.2016.005 Julia Kapelańska-Pręgowska EUROPEAN COURT OF HUMAN RIGHTS (GC), CASE OF LAMBERT AND OTHERS V. FRANCE, JUDGMENT OF 5 JUNE 2015, APPLICATION NO. 46043/14 Abstract This case commentary provides an analysis of the judgment of 5 June 2015 in Lambert and others v. France, handed down by the Grand Chamber of the European Court of Human Rights. The case at issue concerned the discontinuation of treatment (artificial nutrition and hydration) of a patient who was unconscious and not able to express his wishes. It can undoubtedly be classified as one of the “hard cases” decided by the ECtHR, as it touches upon end-of-life dilemmas and the scope of patient’s autonomy. Legal regulation of these issues proves to be very difficult because it needs to avoid vagueness and has to balance conflicting interests and rights. This comment proceeds as follows. Part I offers introductory remarks and explains the fundamental nature of the underlying dilemmas. Part II describes the basic facts of the case, followed by part III which describes the scope of the claim. Part IV discusses admissibility questions – that is – of locus standi and jurisdiction ratione personae. The next part provides some insight into the French legislation concerning the rights of patients in end-of-life situations (Loi Leonetti). Part VI discusses major questions that have been raised in the judgment. The final part offers some conclusions and points for further discussion. Keywords persistent/obstinate therapy – medical futility – incompetent patients – informed consent – advanced directives – patient’s autonomy – right to life – State’s positive obligations Juris doctor (2010). -
The Case of Tony Bland
The case of Tony Bland Anthony David “Tony” Bland was born on 21 st September 1970 and died of deliberately induced kidney failure on 3rd March 1993. He was injured in the Hillsborough disaster, named after the football stadium where 95 people died and many others were injured, as a result of thousands of fans being pushed and crushed against steel fencing, installed to prevent hooliganism. Tony Bland suffered severe injures and he stopped breathing. His brain was deprived of oxygen, and by the time breathing was restored his upper brain had been severely damaged, leaving him in the misnamed “persistent vegetative state .”1 This is a condition of chronic wakefulness without awareness, in which the person responds in a reflex way, but not in a voluntary, purposeful way. It is frequently misdiagnosed. 2 Tony Bland was neither dead nor dying. His brain stem still functioned; he could breathe and digest food normally. He was fed by a nasogastric tube, and evacuated by catheter and enema. Infections were treated with antibiotics. Both his doctor, Jim Howe, and his parents wanted to stop assisted feeding and all medical treatment so that he would die. Only four months after his accident Dr Howe decided that feeding and antibiotics should be discontinued, but the Coroner advised him that directly causing Tony Bland’s death might result in criminal proceedings. Paradoxically, Howe had previously treated serious conditions in Tony Bland including pneumonia, urinary fistula and septicaemia 3 before applying to the courts for permission to stop feeding and hydrating him. Howe claims that he treated Tony Bland’s serious medical problems, from which he might well have died naturally, on the advice of a barrister he consulted from the local Regional Health Authority. -
EUTHANASIA-Misra.Pdf
1 REPORTABLE IN THE SUPREME COURT OF INDIA CIVIL ORIGINAL JURISDICTION WRIT PETITION (CIVIL) NO. 215 OF 2005 Common Cause (A Regd. Society) ...Petitioner(s) Versus Union of India and Another …Respondent(s) J U D G M E N T Dipak Misra, CJI [for himself and A.M. Khanwilkar, J.] I N D E X S. No. Heading Page No. A. Prologue 3 B. Contentions in the Writ Petition 10 C. Stand in the counter affidavit and the 14 applications for intervention D. Background of the Writ Petition 18 D.1 P. Rathinam’s case – The question of 19 unconstitutionality of Section 309 of the Indian Penal Code D.2 Gian Kaur’s case – The question of 22 unconstitutionality of Section 306 of 2 the Indian Penal Code D.3 The approach in Aruna Shanbaug qua 30 Passive Euthanasia vis-à-vis India D.4 The Reference 42 E. Our analysis of Gian Kaur 45 F. Our analysis of Aruna Shanbaug qua 51 legislation G. The Distinction between Active and Passive 52 Euthanasia H. Euthanasia : International Position 58 H.1 U.K. Decisions: 58 H.1.1 Airedale Case 58 H.1.2 Later Cases 79 H.2 The Legal position in the United 89 States H.3 Australian Jurisdiction 96 H.4 Legal position in Canada 99 H.5 Other Jurisdictions 104 H.6 International considerations and 107 decisions of the European Court of Human Rights (ECHR) I The 241st Report of The Law Commission of 114 India on Passive Euthanasia J. Right to refuse treatment 120 3 K. -
Is the Sanctity of Life Ethic Terminally Ill?
Biocfhics ISSN 0269-9702 Volume 9 Numbn 31’4 199.5 PRESIDENTIAL ADDRESS: IS THE SANCTITY OF LIFE ETHIC TERMINALLY ILL? PETER SINGER ABSTRACT Our growing technical capacity to keep human beings alive has brought the sanctity of l$e ethic to the point of collapse. The sh$t to a concept of brain death was already an implicit abandonment of the traditional ethic, though this has only recently become apparent. The 1993 decision ofthe British House of Lords in the case of Anthony Bland is an even more decisive sh$t towardr an ethic that does not ask or seek to preserve human l$e as such, but only a l$e that is worth living. Once this sh$t has been completed and assimilated, we will no longer need the concept of brain death. Instead we can face directly the real ethical issue: when may doctors intentionally end the l$e of a patient? I INTRODUCTION It is surely no secret to anyone at this Congress that I have for a long time been a critic of the traditional sanctity of life ethic. So if I say that I believe that, after ruling our thoughts and our decisions about life and death for nearly two thousand years, the traditional sanctity of life ethic is at the point of collapse, some of you may think this is mere wishful thinking on my part. Consider, however, the following three signs of this impending collapse, which have taken place - coincidentally but perhaps appropriately enough - during the past two years in which I have had the honour of holding the office of President of the International Association of Bioethics. -
Es Éticamente Aceptable? Revista Colombiana De Gastroenterología, Vol
Revista Colombiana de Gastroenterología ISSN: 0120-9957 [email protected] Asociación Colombiana de Gastroenterologia Colombia Peñaloza Ramírez, Arecio; Suárez Correa, Juliana; Blanco Rubio, Luis; Peñaloza Rosas, Arecio Gastrostomía endoscópica percutánea: ¿Es éticamente aceptable? Revista Colombiana de Gastroenterología, vol. 28, núm. 2, abril-junio, 2013, pp. 150-160 Asociación Colombiana de Gastroenterologia Bogotá, Colombia Available in: http://www.redalyc.org/articulo.oa?id=337731609010 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative Point of view Is percutaneous endoscopic gastrostomy ethically acceptable? Arecio Peñaloza Ramírez, MD,1 Juliana Suárez Correa, MD,2 Luis Blanco Rubio MD, MSc,3 Arecio Peñaloza Rosas, MD.4 1 Fellow of the Society for Surgery of Bogota, Chief Abstract of the Gastroenterology and Digestive Endoscopy Program at the Fundación Universitaria de Ciencias Percutaneous endoscopic gastrostomy has become the technique of choice. Nevertheless, because of its de la Salud of the Sociedad de Cirugía de Bogotá, easy introduction, it is used for patients and under circumstances which are very questionable. Currently, what Chief of the Gastroenterology and Digestive is considered ordinary and what is considered extraordinary in the care of patient has become a very common Endoscopy Service at Hospital de San José in Bogota, Colombia debate. Technology has evolved that can keep humans alive, who years ago would have died as a result of 2 Gastroenterology and Digestive Endoscopy Resident the natural course of their diseases. -
The Concept of Autonomy in End-Of-Life Decisions: Ethical and Legal Regulation Regarding Advance Directives
Alma Mater Studiorum – Università di Bologna In collaborazione con LAST-JD consortium: Università degli studi di Torino Universitat Autonoma de Barcelona Mykolas Romeris University of Vilnius Università di Lussemburgo Tilburg University DOTTORATO DI RICERCA IN Erasmus Mundus Joint International Doctoral Degree in Law, Science and Technology Ciclo 28 – A.Y. 2012/2013 Settore Concorsuale di afferenza: 12H3 Settore Scientifico disciplinare: IUS20 The Concept of Autonomy in End-of-Life Decisions: Ethical and Legal Regulation regarding Advance Directives Presentata da: Denard Veshi Esame finale anno 2016 Introduction ………………………………………………………………………………………………… p. 5 Chapter 1. End-of-Life Decisions and the Right to Autonomy Abstract ..…………………………………….……………………………………………………………… p. 10 1. The connection between ethics and law in end-of-life decisions ……. p. 12 2. The European legal models analysed …………………………...…………………... p. 18 3. Moving beyond the limits of the individualism model of autonomy: the concept of relational autonomy ……………………………………………....………... p. 26 4. The significance of advance directives ………………………………….………….. p. 33 4.1. The main critiques regarding the recognition of advance directives ……………………………………………………..…………….………….. p. 35 5. The two forms of advance directives ………………………………….…………….. p. 37 5.1. Moral reasons for supporting the role of the legal proxy in end- of-life decisions …………………………………………..…………….………….. p. 42 6. The position of national courts in some of the most important case law …………………………………………..…………….……………………………………………..…….. p. 47