DOCSLIB.ORG

CHAPTER 3 Nonmaleficence and Beneficence

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
CHAPTER 3 Nonmaleficence and Beneficence 73274_Morrison_Ch03.qxd 9/11/09 7:43 AM Page 47 CHAPTER 3 Nonmaleficence and Beneficence Love and kindness are never wasted. They always make a difference. —Barbara De Angelis Points to Ponder 1. How does the principle of nonmaleficence affect the healthcare administrator’s (HCA) role in the organization? 2. How can you avoid causing harm to employees? 3. What does the principle of beneficence have to do with operating a healthcare organization? Words to Remember The following is a list of key words for this chapter. You will find them in bold in the text. Stop and check your understanding of them. beneficence nonmaleficence I INTRODUCTION AND DEFINITIONS This chapter presents two parallel principles of ethics: nonmaleficence and beneficence . Some ethics writers view these principles as inseparable cousins. Others argue that nonmaleficence is the strongest obligation of the two. Whatever the relationship, these two areas are central to a trust-based healthcare system because they are assumed by society and 73274_Morrison_Ch03.qxd 9/11/09 7:43 AM Page 48 48 CHAPTER 3 NONMALEFICENCE AND BENEFICENCE individuals to be its pillars of practice. This has been the case as far back as Hippocrates, who recognized these duties in his oath of practice. Just what do these words mean? Nonmaleficence involves an ethical and legal duty to avoid harming others (Beauchamp & Childress, 2008). It is based on the Latin maxim primum non nocere or “First, do no harm.” This principle involves areas of healthcare practice including treatment procedures and the rights of patients. In addition, it has an impact on how you treat employees in your practice as an HCA. You will read more about these applications in this chapter’s section on nonmaleficence. In health care, you go beyond avoiding harm to people. Your obliga- tion is to create benefit and contribute to optimum health for individu- als and the community at large. This obligation is called beneficence. Beneficence includes the obligation to help those in trouble, protect patients’ rights, and provide treatment for people who need it. Kantians agree that these obligations exist because you are dealing with the basic needs of humanity and because all people have value. However, in day- to-day healthcare decisions, the utilitarian view of beneficence is often used. This involves balancing benefits of a healthcare decision against its harms. Avoiding the absolutes of Kantian logic, practice or policy deci- sions are made on this reciprocity. You will read more about benefi- cence and its implications for you as an HCA later in this chapter. I NONMALEFICENCE IN HEALTHCARE SETTINGS First, do no harm. How can this be part of the principles of ethics in today’s technology-centered healthcare system? Do you not have to cause patients pain and suffering to cure them? Should you not use invasive diagnostic tests and blood work to provide optimal care? Should we con- sider the emotional pain of receiving a diagnosis? Certainly this “first, do not harm” concept does not mean that you cannot ever cause harm to patients in order to treat them. Sometimes harmful action is necessary, but it should never be automatic. The benefits that you provide through your procedure should outweigh the suffering that you cause. Nonmaleficence has been upheld in both the ethical and legal prac- tices of health care. Using utilitarian logic, the benefit of procedures is balanced against the harm. If there is greater benefit, the act is viewed as an ethical one. In fact, you have a duty to provide appropriate care to avoid further harm to the patient under what some legal texts call a due care standard. This basically means that you have taken all necessary action to use the most appropriate treatment for the condition and have provided that treatment with the least amount of pain and suffering pos- sible. From an administrative standpoint, the care should be provided by professionals with appropriate levels of education and training. Policies 73274_Morrison_Ch03.qxd 9/11/09 7:43 AM Page 49 Nonmaleficence in Healthcare Settings 49 for safety and protection of the patient’s physical health and dignity are applied to avoid harm. Infection control and other environmental prac- tices are also part of the process of providing care and avoiding harm. Therefore, your patients receive care with a trust that it will not cause them harm even if some pain and suffering is involved. Like many other areas of health care, nonmaleficence is complicated when advanced technology is part of the regimen. Issues around with- holding or withdrawing life support, extraordinary measures, and death with dignity involve decisions about avoiding further harm to the indi- vidual. For example, healthcare professionals and family members seem to be more comfortable with withholding (i.e., not starting) treatment than withdrawing it. Somehow, what has come to be called “pulling the plug” seems more harmful to the patient than not starting the technol- ogy to support life. The line between extraordinary and ordinary care has become murkier with the advent of advanced life-sustaining tech- nology. The now classic Terri Schiavo case is an excellent example of this level of complexity. It used to be that health care did not go to extraordinary efforts when there was no hope of benefit. However, family members, educated in the marvels of modern medicine, changed this view. The family might see what used to be called extraordinary measures as ordinary and appropriate for their loved one. Even some physicians who see death as a failure might advocate for care that pro- longs some form of life but increases the suffering of the individual. How does your work affect nonmaleficence for patients? Of course, you are not actually treating the patient, but you create an environment where this principle can be applied. For example, if advance directive policies are not in place and are not clearly written, you may be involved in policy development or refinement. If they are in place, you certainly will be involved in making sure that they are implemented appropriately. This responsibility will include periodic staff education so that staff members are clear about their responsibilities and actions. In addition, you might be working closely with an ethics committee who can advise you when challenging situations occur. Nonmaleficence and Staff The application of the principle of nonmaleficence is not restricted to patient treatment. It also must be considered when dealing with any member of the healthcare staff. You have an ethical obligation to pro- vide a working environment that is safe and does not harm your employees. Such an environment allows for discussion of concerns without fear of reprisal. It should also be a positive environment where values are respected and employees can do their best work on behalf of the patients they serve (this is the I-YOU relationship). This environ- ment should be free of harassment, imposition, and discrimination for all employees, regardless of their status in the organization. 73274_Morrison_Ch03.qxd 9/11/09 7:43 AM Page 50 50 CHAPTER 3 NONMALEFICENCE AND BENEFICENCE Creation of a positive environment or climate of trust can go a long way to ensure the implementation of the principle of nonmaleficence for employees. However, situations can occur that are potentially a vio- lation of this principle. Certainly, downsizing has a potential to cause the staff great personal and professional harm. How can you imple- ment a layoff plan and cause the least amount of harm to employees? The American College of Healthcare Executives (ACHE) gives you some assistance through its Policy Statement—Ethical Issues Related to a Reduction in Force (ACHE, 2005). This statement urges you to con- sider both the long- and short-term impact of this decision, not only on those who will lose their jobs, but also on those who will remain in the organization. Survivor guilt can often be destructive to a positive work- place and productivity. The ACHE also stresses the need for frequent and accurate commu- nication with all those involved in the layoffs and the provision of as much support as possible for those who lose their jobs. Often, adminis- trators try to avoid communication about layoffs because they fear dis- ruption and loss of productivity. In keeping information from affected employees, they are trying to balance their view of benefits versus harm. Knowledge of what is to happen is kept to a select group. Inevitably, the rumor mill will take over for the void in accurate communication and make the situation worse. Even though it might seem to make your bur- den easier in a difficult situation, silence is truly not golden and can cause unnecessary harm. It is equally important to remember those who remain after a layoff. There can be an administrative attitude of “You should think yourself lucky to have a job” and a lack of empathy for the feelings of survivors. This attitude causes unnecessary harm because it fails to acknowledge the human reaction of “Why them and not me?” or survivor guilt. Care should be taken to acknowledge what has occurred and allow time for processing the feelings associated with it. This can be done through sev- eral channels of communication including meetings, newsletters, and e-mails. In addition, communication needs to be ongoing regarding workload expectations and the potential for any future reductions in the workforce. As an administrator, you will be dealing with diversity on many lev- els. Your staff are educationally diverse in that they represent a range of credentials from a GED to an MD/DO. They are also professionally diverse because they come from many different professional back- grounds, each with its own culture.
Load more

Recommended publications
  • Did I Do That?
    Did I Do That? ISSUES IN COMMUNICATION, DOCUMENTATION, AND RISK IN HEALTHCARE DECISIONS. Andy McLean, MD, MPH OBJECTIVES Describe risk and protective factors in doctor-patient communication Understand the importance of appropriate health record documentation in the era of patient-centered care Articulate an awareness of how to “expand the field” when involved in difficult healthcare decisions The Art of Medicine Medical Ethics • 4 Principles: • Autonomy* • Beneficence- (Dr. should act in Pt. best interest) • Non-Maleficence- “primum non nocere” prē-mu m-̇ ˌnōn-no -̇ ˈkā-rā (first, do no harm) Justice-fairness (as in, allocation of resources) Harm combinations Resulting from the underlying Resulting from the care/services medical condition provided to the patient Inherent risk of treatment Systems failure Provider performance Canadian Medical Protective Association What happened? Duty-A physician has a duty to provide competent care to a patient Breach-Did the physician’s conduct, whether by act or omission, fall below the applicable standards of care? Causation- “But for…” Proximate cause (foreseeability) Damages Breach- Omissions of Fact and Judgment Fact- Did you review all the facts you knew or should have known… Judgment- Once reviewed, did you make a reasonable clinical decision, and document such? It is recognized that physician’s aren’t perfect and that even with reasonable care, negative outcomes occur. You are much more likely to be “forgiven” if you documented how you weighed your decision (based on the facts…) “Foreseeability”
    [Show full text]
  • Defining Remission in Rheumatoid Arthritis: What Is It? Does It Matter?
    Editorial Defining Remission in Rheumatoid Arthritis: What Is It? Does It Matter? When the American College of Rheumatology (ACR) criteria for remission include 6 signs and symptoms: fatigue, preliminary criteria for remission1 were developed in 1981, joint pain, morning stiffness, joint tenderness, joint patients with established rheumatoid arthritis (RA) rarely swelling, and erythrocyte sedimentation rate (ESR); phys- experienced remission, although a number of patients with ical function and structural damage to joints are ignored. recent onset of polyarthritis had periods when their RA The DAS (Disease Activity Score) index uses a mathemat- temporarily regressed or remitted and a few had prolonged ical formula to arrive at a single composite quantitative remission or even permanent recovery from the disease. score representing tender joints (Ritchie index), swollen This was more frequent in children with oligoarthritis, and joints (44-joint count), Westergren ESR and patient’s global was generally considered to be a gift from God. The guiding assessment (0–100 visual analog scale) of disease activity6. principle for treatment of RA was “primum non nocere,” It is a useful continuous quantitative summary measure of exemplified by the therapeutic pyramid. Because RA was signs and symptoms of RA inflammation, similar to the expected to persist for the lifetime of the patient, available signs and symptoms included in the dichotomous ACR drugs were used cautiously so one would not run out of ther- remission criteria, but also ignores physical function and apeutic options too rapidly. For most patients therapy had structural damage. The DAS-28 uses the abbreviated 28- little effect on continued disease progression.
    [Show full text]
  • Physician Responsibility on the Frontiers of Tort Law
    DePaul Law Review Volume 57 Issue 2 Winter 2008: Symposium - Challenges to the Attorney-Client Relationship: Threats to Article 6 Sound Advice? Dissembling and Disclosing: Physician Responsibility on the Frontiers of Tort Law Robert L. Rabin Follow this and additional works at: https://via.library.depaul.edu/law-review Recommended Citation Robert L. Rabin, Dissembling and Disclosing: Physician Responsibility on the Frontiers of Tort Law, 57 DePaul L. Rev. 281 (2008) Available at: https://via.library.depaul.edu/law-review/vol57/iss2/6 This Article is brought to you for free and open access by the College of Law at Via Sapientiae. It has been accepted for inclusion in DePaul Law Review by an authorized editor of Via Sapientiae. For more information, please contact [email protected]. DISSEMBLING AND DISCLOSING: PHYSICIAN RESPONSIBILITY ON THE FRONTIERS OF TORT LAW Robert L. Rabin* INTRODUCTION This Commentary addresses an issue that emerges as a common theme in the three papers in this Symposium Issue dealing with legal considerations in advising physicians: are there circumstances in which telling "less than the whole truth" is warranted?1 In a bygone era, physicians would have had no difficulty providing an affirmative answer to this question. Well into the twentieth century, it was com- mon practice to withhold from patients the dire news that they suf- fered from a terminal illness. In a different context, the consensus view until the latter part of the century was the so-called "physician's standard" in informed consent cases; that is, the practice of informing a patient of only those risks associated with an anticipated medical procedure that the physician deemed advisable to disclose to the pa- tient.
    [Show full text]
  • Code Gray.Pub
    Written by Christine Mitchell, RN, FAAN and Ben Achtenberg with a historical commentary by Susan Reverby, PhD and assistance from Joan Sawyer and Karen Wolf, RN, MS Contents INTRODUCTION ....................................................................................... 3 Background ............................................................................................3 Synopsis of the Film ..............................................................................3 Suggested Uses .......................................................................................4 Scheduling ..............................................................................................4 FILM AS A TOOL FOR DISCUSSION .......................................................4 WHAT IS NURSING ETHICS? ...................................................................5 GLOSSARY ...................................................................................................5 SOME GENERAL DISCUSSION QUESTIONS ........................................6 CASE 1: BENEFICENCE ............................................................................7 Description of the Case .........................................................................7 The Principle: Beneficence ...................................................................7 Questions for Discussion ......................................................................8 CASE 2: AUTONOMY ................................................................................9 Description
    [Show full text]
  • First, Do No Harm”: Old and New Paradigms in Prehospital Resuscitation in the Aquatic Domain
    International Journal of Aquatic Research and Education Volume 10 Number 2 Article 5 10-16-2017 “First, Do No Harm”: Old and New Paradigms in Prehospital Resuscitation in the Aquatic Domain John H. Pearn Lady Cilento Children's Hospital, Brisbane, Queensland, Australia, [email protected] Richard Charles Franklin James Cook University, [email protected] Follow this and additional works at: https://scholarworks.bgsu.edu/ijare Part of the Applied Ethics Commons, Bioethics and Medical Ethics Commons, Health and Physical Education Commons, Legal Theory Commons, Leisure Studies Commons, Medicine and Health Commons, Social and Philosophical Foundations of Education Commons, and the Social Control, Law, Crime, and Deviance Commons Recommended Citation Pearn, John H. and Franklin, Richard Charles (2017) "“First, Do No Harm”: Old and New Paradigms in Prehospital Resuscitation in the Aquatic Domain," International Journal of Aquatic Research and Education: Vol. 10 : No. 2 , Article 5. DOI: https://doi.org/10.25035/ijare.10.02.05 Available at: https://scholarworks.bgsu.edu/ijare/vol10/iss2/5 This Education Article is brought to you for free and open access by the Journals at ScholarWorks@BGSU. It has been accepted for inclusion in International Journal of Aquatic Research and Education by an authorized editor of ScholarWorks@BGSU. Pearn and Franklin: First, Do No Harm Abstract The balance between benefit and risk is central to the work of all those involved in aquatic services. The Hippocratic exhortation of Primum non nocere, “First, do no harm,” has a history of over 2000 years. Superficially, all would support this dictum, but harm can result from inaction.
    [Show full text]
  • The Hippocratic Oath and Principles of Medical Ethics
    MEDICINE AND PUBLIC POLICY The Hippocratic Oath and Principles of Medical Ethics Gilbert Berdine MD The Hippocratic Oath is associated with the morally right. This tradition remains in the modern practice of medicine, but over time fewer medical era. “As God is my witness I hereby pledge to …” can graduates have taken any form of the Hippocratic be found in modern rituals to stress the seriousness Oath. As of 2006, the State University of New York of purpose. Courts in the U.S. require prospective Upstate Medical School in Syracuse was the only witnesses to pledge their truthfulness: “Do you sol- U.S. medical school that administered the classic emnly swear or affirm that you will tell the truth, the version of the Hippocratic Oath to its graduates. The whole truth, and nothing but the truth, so help you Hippocratic Oath has been revised to make it more God?” This pledge becomes a source of contention in acceptable to modern schools, but the medical pro- a multi-cultural society as some members believe in fession no longer has a common set of promises that other deities. guide it. This article will look at the classic version of the Hippocratic Oath to see why it has been aban- Anyone who takes his or her religion seriously doned. Modern medical students wish to graduate would not pledge to a pagan god as this would be a into an ancient order of physicians, so they long for form of idolatry. This pledge is probably the main rea- a solemn ceremony, but it is difficult to craft a solemn son that the Oath has been abandoned in the modern ceremony that remains agreeable to a diverse group era, but what can take its place as a symbol of seri- of students.
    [Show full text]
  • Primum Non Nocere
    65 à la mort. Cependant, la formation en Primum Non oncologie met l’accent sur le trait- ement du cancer et fait très peu de Nocere: place à la relation d’aide en prépa- Reflections of a ration à la mort. Des médecins tels Bahá’í Oncologist que l’écrivain Atul Gawande veulent ramener le sujet de la mort dans la about Treating the conversation entre le médecin et Dying Patient le patient. De plus, bon nombre de religions, dont la foi bahá’íe, peuvent aider à examiner comment les mé- AARON ALIZADEH decins perçoivent et abordent le sujet de la mort. Dans le présent article, je Dedicated to Carley Elle Allison traite de mon expérience personnelle en tant qu’oncologue et en tant que July 18 1995 - March 31 2015 bahá’í en ce qui concerne le sujet de la mort. Abstract Medical oncology is a subspecialty of Resumen internal medicine that focuses on the Oncología médica es una subespecialidad treatment of cancer. Cancer is the sec- de la medicina interna que se encarga en el ond leading cause of mortality in the U.S. tratamiento del cáncer. El cáncer es la se- Therefore death is a frequent subject for gunda causa de mortalidad en los Estados oncologists. However, oncology train- Unidos. Por lo tanto la muerte es un tema ing emphasizes cancer therapy with little frecuente para los oncólogos. Sin embargo, guidance on counseling in preparation for la formación oncológica enfatiza el trata- death. Physicians such as the writer Atul miento del cáncer con poca orientación en Gawande are working to bring back the la preparación para la muerte.
    [Show full text]
  • Medical Ethics
    Medical Ethics Janyne Althaus, M.D., M.A. Dept. Gyn-Ob Div. Maternal-Fetal Medicine Johns Hopkins University School of Medicine Hippocratic Oath 12th-century Byzantine manuscript of the Oath Late 5th Century B.C. Basic Principles of Medical Ethics 1. Non-maleficence 2. Beneficence 3. Autonomy 4. Justice Primum non nocere Bloodletting High Oxygen for respiratory distress in premature infants Healing should be the sole purpose of medicine, and that endeavors like cosmetic surgery, contraception & euthanasia fall beyond its purview. Jehovah’s Witnesses Primary Elective Cesareans Cosmetic Gynecology Counseling parents of 24 week fetus Neonatal Intensive Care Units Transplants Forced sterilization of mentally retarded in Virginia United States of America v. Karl Brandt, et al. A sentence of death by hanging is pronounced by a US War Crimes Tribunal upon Adolf Hitler's personal physician, 43-year old Karl Brandt. Brandt was also Reich Commissar for Health and Sanitation. Of the 23 defendants, 7 were acquitted and 7 received death sentences; 9 received prison sentences ranging from 10 years to life imprisonment. Tuskegee Syphilis Experiment Peter Buxtun, PHS veneral disease investigator, the “whistleblower". •Conducted by the U.S. Public Health Service from 1932-1972 •600 Rural African-American men thought they were receiving free health care from the government. •By the end of the study in 1972, only 74 of the test subjects were alive. Of the original 399 men with syphilis, 28 had died of syphilis, 100 were dead of related complications, 40 of their wives had been infected and 19 of their children were born with congenital syphilis.
    [Show full text]
  • Daniel Patrick Moynihan and the Defense of Academic Medicine
    10 The Pharos/Spring 2017 Primum non nocere: Daniel Patrick Moynihan and the defense of academic medicine Joseph J. Fins, MD, MACP; Joan M. Leiman, PhD; and Herbert Pardes, MD Dr. Fins (AΩA, Weill Cornell Medical College, 2011, ...[M]edical education was one of the issues that Pat was Faculty) is the E. William Davis, Jr., MD, Professor of most interested in. He was deeply concerned with poverty Medical Ethics; Chief of the Division of Medical Ethics; in America & always worked on issues connected to that. Professor of Medicine; Professor of Medicine in Psychiatry; He also felt that the most important duty of a Senator was Professor of Medical Ethics in Neurology; and Professor to choose the best men/women as Federal judges. These of Health Care Policy and Research at Weill Medical were the 3 issues he cared most about…1 College of Cornell University. He is also the Director of Medical Ethics at New York-Presbyterian Weill Cornell Although Moynihan was not alone in his advocacy for Medical Center; Solomon Center Distinguished Scholar in academic medicine, it became one of his key legislative pri- Medicine, Bioethics and the Law at Yale Law School; and orities. While other leaders, like Senator Ted Kennedy (D- a member of The Pharos Editorial Board. MA) focused more on universal access to care, Moynihan’s Dr. Leiman is a Fellow at the New York-Presbyterian focus increasingly became the fate of academic medicine. Health Policy Center. Adam Clymer of The New York Times observed that Dr. Pardes (AΩA, State University of New York, Downstate Moynihan, “… carped on television about their [Clintons’] Medical Center, 1960) is Executive Vice Chairman, and health plan, quickly fixing on the role of teaching hospitals former President and CEO of New York-Presbyterian as the biggest issue in health care.” 2 Hospital.
    [Show full text]
  • The Medlaw Update and Health Care Law Committee
    The newsletter of the Medical Liability The MedLaw Update and Health Care Law Committee 10/15/2018 Volume 23 Issue 2 Feature Article Deflating Plaintiffs’ Use of the Hippocratic Oath in Medical Negligence Cases By Matthew Moriarty Lawyers representing plaintiffs in medical neg- for simple sound bites they can later display to a jury. ligence cases often ask doctors about their Conceding these points can usually be avoided, however, having taken the Hippocratic Oath. They want because the Hippocratic Oath questions are built upon a to gain a simple concession from the physician complete myth; contrary to common belief, medical oaths that they swore to uphold the principle of “pri- do not contain such a statement of primary duty. mum non nocere,” which means “first do no harm.” Here is a typical exchange: A Short History of Medical Oaths Q: As part of your job, is one of your ultimate goals when The Hippocratic Oath is the earliest known expression of you have a patient who comes into the emergency room, to medical ethics in the western world. Like many ancient keep them safe from harm? texts, its origins are unclear and its evolution extensive. It Yes. is named after Hippocrates, a Greek physician who report- Q. And you take an oath to do that, right -- do no harm? edly lived from approximately 450–370 B.C.E. But modern scholars are quite certain he did not personally write the A. That is correct. That’s the Hippocratic Oath. oath, asserting the view that it was written by a Pythago- The concept that an oath can give rise to a duty, in and rean sect after studying what is known as the Hippocratic of itself, is not the problem.
    [Show full text]
  • 2020 Annual Report
    ANNUAL REPORT 2020 Thank you so much for your interest in the CAN BOARD MEETINGS AND work of the North Carolina Medical Board. HEARINGS GO DIGITAL? YES. It is tradition for the current NCMB President to orient readers of the Like most organizations and individuals, agency annual report by writing a brief letter highlighting some of the NCMB had to be both resilient and most significant events of the previous calendar year. In a way, though, creative to continue working and serving that does not seem right because the Board Member who is President the public and the profession when the when this report is released takes office in November. That means that coronavirus pandemic hit. most of the work accomplished during the calendar year 2020 happened In mid-March, NCMB closed its Raleigh offices under the watch of my predecessor, Dr. Bryant Murphy, who served as to visitors and most staff transitioned to full- Board President from Nov. 1, 2019 – Oct. 31, 2020. time work-from-home. But perhaps the biggest As you know, 2020 brought a devastating and unwelcome surprise in challenge (among all the challenges COVID-19 the form of the ongoing coronavirus pandemic. NCMB was fortunate to brought) was figuring out how to continue have Dr. Murphy’s steady hand at the helm as this agency, like so many with NCMB’s bi-monthly Board Meetings and other organizations, determined how best to continue its work and be of periodic Hearings amid tight restrictions on service amid the unprecedented challenges of the pandemic. public gatherings. Some key accomplishments related to the pandemic: In May 2020, NCMB converted to a virtual meeting format for the first time in its • Virtually all NCMB staff shifted to full time telecommuting, history.
    [Show full text]
  • Swilling Hemlock: the Legal Ethics of Defending a Client Who Wishes to Volunteer for Execution J
    Washington and Lee Law Review Volume 63 | Issue 1 Article 5 Winter 1-1-2006 Swilling Hemlock: The Legal Ethics of Defending a Client Who Wishes to Volunteer for Execution J. C. Oleson Follow this and additional works at: https://scholarlycommons.law.wlu.edu/wlulr Part of the Legal Ethics and Professional Responsibility Commons Recommended Citation J. C. Oleson, Swilling Hemlock: The Legal Ethics of Defending a Client Who Wishes to Volunteer for Execution, 63 Wash. & Lee L. Rev. 147 (2006), https://scholarlycommons.law.wlu.edu/wlulr/ vol63/iss1/5 This Article is brought to you for free and open access by the Washington and Lee Law Review at Washington & Lee University School of Law Scholarly Commons. It has been accepted for inclusion in Washington and Lee Law Review by an authorized editor of Washington & Lee University School of Law Scholarly Commons. For more information, please contact [email protected]. Swilling Hemlock: The Legal Ethics of Defending a Client Who Wishes to Volunteer for Execution J.C. Oleson* Table of Contents I. Introduction ..................................................................................148 II. Lawyers' Nightmares Do Come True: When the Client Volunteers for Execution ................................................... 150 A. Three Cornerstone Cases of American Capital Jurisprudence ......................................................................... 151 B. Death: A Growth Industry .................................................... 153 C. The Looking-Glass Ethics of the Volunteering Client ..........
    [Show full text]