Tuesday 28 February 2006

Bioethics –End of Life Decision Making

Raphael Cohen-Almagor

Annual Seminar

The seminar aims to explore the issues of physician-assisted suicide and euthanasia from two angles: philosophical and legal, and to combine theory with an empirical study of court cases. It focuses on the following questions: (1) What notions are associated with the term “dignity”? (2) What does it mean to say that human life has an intrinsic value? (3) Whether or not life can be intrinsically important independently of the interests of the person concerned, i.e., how can we accommodate between the model of thinking which holds that human life is inherently valuable and the model of thinking which takes into consideration the autonomy, rights and interests of the individual. More specifically, how can we decide between, say, the duty of keeping a person alive and her right to keep her dignity (which may also be considered as an intrinsic value)? (4) What rights do people who suffer from an incurable disease possess?, and (5) should we honor advance directives and living wills. Finally, (6) does a liberal society have a duty or some form of communal obligation to keep people alive? Here consideration will be given to the financial costs involved in keeping people alive for months, sometimes for years.

Items noted with * are not obligatory.

Grading

Active participation in class (25%);

Presenting a paper in class (25%);

Final paper (50%).

THE RIGHT TO DIE IN DIGNITY

Terminology

Cohen-Almagor, Raphael, "Language and Reality at the End of Life", The Right to Die with Dignity: An Argument in Ethics, Medicine, and Law (Piscataway, NJ.: Rutgers University Press, 2001), chap. 1.

Derse, Arthur, “Is there a lingua franca for bioethics at the end of life?”, Journal of Law, Medicine and Ethics, Vol. 28, No. 3 (Fall 2000), pp. 279-284.

Cohen-Almagor, Raphael, “A Concise Rebuttal”, Journal of Law, Medicine and Ethics, Vol. 28, No. 3 (Fall 2000), pp. 285-286.

Stephen Streat, "Suggestions for Change: An Antipodean View" (working paper).

Autonomy: The Rights and Interests of the Individual

Dworkin, Ronald, Life's Dominion (New York: Knopf, 1993), chaps. 7, 8.

Beauchamp, Tom L. “The Autonomy Turn in Physician-Assisted Suicide”, in R. Cohen-Almagor (ed.), Medical Ethics at the Dawn of the 21^st Century (New York: New York Academy of Sciences, 2000), pp. 111-126.

* Cohen-Almagor, Raphael, The Boundaries of Liberty and Tolerance (Gainesville, FL.: University Press of Florida, 1994), chap. 1.

Mercy Killing

Cohen-Almagor, Raphael, “Sanctity and Quality of Life in Medical Ethics”, in The Right to Die with Dignity: An Argument in Ethics, Medicine, and Law (Piscataway, NJ.: Rutgers University Press, 2001), chaps. 3, 4.

Dickens, Bernard M., "When Terminally Ill Patients Request Death: Assisted Suicide Before Canadian Courts", J. of Palliative Care, Vol. 10, No. 2 (1994), 52-56.

* Klemens Kappel and Peter Sandoe, “QALYs, Age and Fairness”, Bioethics, Vol. 6 (1992), pp. 297-316.

The Role of Physicians

Blendon, Robert J. et al, "Physicians' Perspectives on Caring for Patients in the United States, Canada and West Germany", New England J. of Medicine, Vol. 328, No. 14 (1993), 1011-1016.

Kevorkian, Jack, Prescription: Medicide (Buffalo, N.Y.: Prometheus Books, 1991), chap. 11.

Faber-Langendoen, Kathy and Jason T.H. Karlawish, “Should Assisted Suicide Be Only Physician Assisted?,” Annals of Internal Medicine, Vol. 132 (21 March 2000): 482-487.

Cohen-Almagor, Raphael, Euthanasia in the Netherlands: The Policy and Practice of Mercy Killing (Dordrecht: Springer-Kluwer, 2004), chap. 8.

Singer, Peter A., "Should Doctors Kill Patients?", CMAJ, Vol. 138 (June 1988), pp. 1000-1001.

Ganzini, Linda, Heidi D. Nelson, Terri A. Schmidt, Dale F. Kraemer, Molly A. Delorit, Melinda A. Lee, “Physicians’ Experiences with the Oregon Death with Dignity Act,” New England Journal of Medicine, Vol. 342, No. 8 (February 24, 2000).

Video: 60 Minutes with Jack Kevorkian

* Roy, David J, John R. Williams and Bernard M. Dickens, Bioethics in Canada (Scarborough, Ont.: Prentice Hall, 1994), chap. 5.

* Sawyer, Douglas M, John R. Williams and Frederick Lowy, "Canadian Physicians and Euthanasia: 2. Definitions and Distinctions", Can. Med. Assoc. J., Vol. 148 (May 1993), pp. 1463-1466.

* Elliott, Carl, “Philosophers’ Assisted Suicide and Euthanasia”, BMJ, Vol. 313 (1996), p. 1088.

The Role of the Patient’s Beloved People

Hardwig, John, “The Problem of Proxies with Interests of Their Own,” in Is There A Duty to Die? (New York and London: Routledge, 2000): 45-60.

Cohen-Almagor, Raphael, The Right to Die with Dignity: An Argument in Ethics, Medicine, and Law (Piscataway, NJ.: Rutgers University Press, 2001), chap. 6.

Beauchamp, Tom L. and James F. Childress, Principles of Biomedical Ethics (New York: Oxford University Press, 1994, 4th edition): 170-188.

The Role of Politicians

Florida Governor's Office, EXECUTIVE ORDER NUMBER 03-201,

D:\Files\DIGNITY\U.S.A\Schiavo\Schiavo Controversy Fla_ Gov_ Exec_ Order No_ 03-201.htm (October 21, 2003)

Schiavo v. Schiavo U.S. Court of Appeals for the 11^th Circuit, No. 05-11628, 05-11556 (March 25, 2005).

Michael Schiavo v. Jeb Bush Circuit Court for the 6^th Judicial Circuit in and for Pinellas County, Florida, No. 03-008212-CI-20 (May 5, 2004).

Schindler v. Michael Schiavo District Court of Appeal of Florida, Second District, No. 2DO2-5394 (June 6, 2003).

Michael Schiavo v. Shindler, Circuit Court for the 6^th Judicial Circuit in and for Pinellas County, Florida, No. 90-2908-GD-003 (Nov. 22, 2002).

* Cohen-Almagor, Raphael, The Right to Die with Dignity: An Argument in Ethics, Medicine, and Law (Piscataway, NJ.: Rutgers University Press, 2001), chap. 2.

Living Wills and Advance Directives

Lo, Bernard and Robert Steinbrook, "Resuscitating Advance Directives", Arch Intern Med. Vol. 164 (2004): 1501-1506.

Fisher, Rory H. and Eric M. Meslin, "Should Living Wills Be Legalized?”, Can. Med. Assoc. J., Vol. 142 (1990), pp. 23-26.

Biegler, Paul, Cameron Stewart, Julian Savulescu and Loane Skene, “Determining the Validity of Advance Directives,” Medical J. of Australia, Vol. 172 (2000), 545-548.

Meslin, Eric M. and Kara Sutherland, "Advance Directive Policy in Canada: The Impact on Older People and Their Families", in Jon Hendricks and Carolyn J. Rosenthal (eds.), The Remainder of Their Days: Domestic Policy and Older Families in the United States and Canada (N.Y. and London: Gerland Publishing, 1993), chap. 8.

Robertson, John, "Second Thoughts on Living Wills", Hastings Center Report, Vol. 21, No. 6 (Nov.-Dec. 1991), pp. 6-9.

* Rasooly, Iris et al, "Hospital Policies on Life-Sustaining Treatments and Advance Directives in Canada", Can. Med. Assoc. J., Vol. 150 (April 1994), pp. 1265-1270.

* Editorial, “How Living Wills Can Help Doctors and Patients Talk about Dying,” BMJ, Vol. 320 (17 June 2000): 1618-1619.

* Hughes, David L., "Family Physicians’ Attitudes toward Advance Directives", Canadian Medical Ass. J. (1992), 1937-1944.

The Ethics of Allocation of Scarce Resources

Callahan, Daniel, The Troubled Dream of Life (N.Y.: Simon and Schuster, 1993), pp. 198-219.

Roy, David J, John R. Williams and Bernard M. Dickens, Bioethics in Canada (Scarborough, Ont.: Prentice Hall, 1994), chap. 14.

Helft, Paul R. Mark Siegler and John Lantos, “The Rise and Fall of the Futility Movement,” New England Journal of Medicine, Vol. 343, No. 4 (27 July 2000): 293-296.

Cohen-Almagor, Raphael, “Ethical and Financial Considerations in Allocating Healthcare Resources: A Comparative Analysis”, in The Right to Die with Dignity: An Argument in Ethics, Medicine, and Law (Piscataway, NJ.: Rutgers University Press, 2001), Appendix.

Video: Near Death

Health Care in Canada and the United States

Deber, Raisa B., "Canadian Medicare: Can it Work in the United States? Will it Survive in Canada?", American J. of Law & Medicine, Vol. XIX, Nos. 1-2 (1993), pp. 75-93.

Callahan, Daniel, "Introduction", False Hopes: overcoming the obstacles to a sustainable, affordable medicine (New Brunswick, NJ: Rutgers University Press, 1999).

Lowy, Frederick H., "Restructuring Health Care: Rationing and Compromise", Humane Medicine, Vol. 8, No. 4 (October 1992), pp. 263-267.

Singer, Peter A., "How Green Is Your Grass: A Comparative Analysis of the American and Canadian Health Care Systems", Human Medicine, Vol. 7, No. 1 (Winter 1991), pp. 47-53.

Roy, David J, John R. Williams and Bernard M. Dickens, Bioethics in Canada (Scarborough, Ont.: Prentice Hall, 1994), chap. 4.

CASE STUDIES

CANADA

Sue Rodriguez v. the Attorney General of Canada, File No. 23476, (September 1993).

Somerville, Margaret A., "'Death Talk' in Canada: The Rodriguez Case", McGill L. J., Vol. 39 (1994), pp. 602-617.

Nancy B. v. Hotel-Dieu de Quebec [1992] R.J.Q. 361, 86 D.L.R. (4th) 385 (Sup. Ct.).

Fish, Arthur et al., "Nancy B.: the Criminal Code and Decisions to Forgo Life-Sustaining Treatment", Canadian Medical Ass. J. , Vol. 147, No. 5 (1992), pp. 637-642.

Malette v. Shulman 72 Ontario Reports (2nd Series).

Video: The Sue Rodriguez story

* Dickens, Bernard M., "Medically Assisted Death: Nancy B. v. Hotel-Dieu de Quebec, McGill Law Journal, Vol. 38, No. 4 (October 1993), pp. 1053-1070.

* Kluge, Eike-Henner, "Doctors, Death and Sue Rodriguez", Can. Med. Assoc. J., Vol. 148, No. 6 (1993), pp. 1015-1017.

* Mullens, Anne, "Society Must Lead in Determining Canadian Position on Euthanasia, Doctors Say", Can. Med. Assoc. J., Vol. 148, No. 8 (1993), pp. 1363-1367.

* Singer, Peter A., and Frederick H. Lowy, "Refusal of Life-Sustaining Treatment, The Malette Case, and Decision-Making Under Uncertainty", Annals RCPSC, Vol. 24, No. 6 (October 1991), pp. 401-403.

* Of Life and Death, Report of the Special Senate Committee on Euthanasia and Assisted Suicide (June 1995).

U.S.A

Matter of Quinlan, 355 A.2d 647 (1976).

Superintendent of Belchertown v. Saikewicz, Mass 370 N.E.2d 417 (1977).

In Matter of Spring, Mass. App. 399 N.E.2d 493 (1979).

Gray by Gray v. Romeo 697 F.Supp. 580 (D.R.I. 1988).

Dennis C. Vacco, Attorney General of New York et al., Petitioners v. Timothy Quill et al, S. Ct. (June 26, 1997)

Cruzan v. Harmon, 760 S.W.2d 408 (Mo.banc 1988).

Cruzan v. Director Mo. Health Dept., 497 U.S. 261 (1990), 110 S.Ct. 2841.

Cohen-Almagor, Raphael and Monica G. Hartman, “The Oregon Death with Dignity Act: Review and Proposals for Improvement”, Journal of Legislation, Vol. 27, No. 2 (2001), pp. 269-298.

* Dworkin, Ronald, "The Right to Death", The New York Review of Books, Vol. XXXVIII, No. 3 (1991), pp. 14-17.

* Korobkin, Russell, “Physician-assisted Suicide Legislation: Issues and Preliminary Responses,” Notre Dame J. of Law, Ethics & Public Policy, Vol. 12, No. 2 (1998).

BRITAIN

Queen on the application of Dianne Pretty v. Director of Public Prosecutions and Secretary of State for the Home Department [2001] UKHL 61 (29 November 2001).

Airedale NHS Trust v. Bland, [1993] 1 All ER.

Finnis, J.M., "Bland: Crossing the Rubicon", The Law Quarterly Rev., Vol. 109 (July 1993), pp. 329-337.

Keown, John, "Doctors and Patients: Hard Case, Bad Law, 'New' Ethics", Cambridge L. J., Vol. 52, No. 2 (1993), pp. 209-213.

THE NETHERLANDS

Onwuteaka-Philipsen, B.D., A. van der Heide, D. Koper, I. Keij-Deerenberg, J.A.C. Rietjens, M.L. Rurup, A.M. Vrakking, J.J. Georges, M.T. Muller, G. van der Wal, P.J. van der Maas, "Euthanasia and Other End-of-life Decisions in the Netherlands in 1990, 1995, and 2001," Lancet, Vol. 362 (August 2, 2003): 395–399.

Cohen-Almagor, Raphael, Euthanasia in the Netherlands: The Policy and Practice of Mercy Killing (Dordrecht: Springer-Kluwer, 2004), chaps. 1, 2.

Nys, Herman, "Euthanasia in the Low Countries: A Comparative Analysis of the Law Regarding Euthanasia in Belgium and the Netherlands," Ethical Perspectives, Issue 9/2 (June 2002): 73–85.

Video: Death on Request

* Battin, Margaret P., “Voluntary Euthanasia and the Risks of Abuse: Can We Learn Anything from the Netherlands”?, Law, Medicine and Health Care, Vol. 20, Nos. 1-2 (Spring-Summer 1992), pp. 133-143.

* Griffiths, John, “Effective Regulation of Euthanasia and Other Medical Behavior that Shortens Life”, in Ejan Mackaay (ed.), Uncertainty and the Law (Montreal: Editions Themis, 1999), pp. 61-94.

* Battin, Margaret P., The Least Worst Death (New York: Oxford University Press, 1994).

* van Leeuwen, Evert, and Gerrit Kimsma, “Problems Involved in the Moral Justification of Medical Assistance in Dying: Coming to Terms with Euthanasia and Physician Assisted Suicide”, in R. Cohen-Almagor (ed.), Medical Ethics at the Dawn of the 21^st Century (New York: New York Academy of Sciences, 2000).

* Fenigsen, R. “Mercy, Murder and Morality: Perspectives on Euthanasia. A Case Against Dutch Euthanasia”, Hastings Center Report, Vol. 19, No. 1 (Supp.) (1989), pp. 22-30.

BELGIUM

Bilsen, Johan et al., "Physician-assisted Death: Attitudes and Practices of Community Pharmacists in East Flanders, Belgium", Palliative Medicine, Vol. 19 (1005): 151-157.

Deliens, Luc, and Jan Bernheim, "Palliative Care and Euthanasia in Countries with a Law on Euthanasia," Palliative Medicine, Vol. 17 (2003): 393–394.

Deliens, Luc et al., “End-of-life Decisions in Medical Practice in Flanders, Belgium: A Nationwide Survey”, Lancet, 356 (25 November 2000), 1806-11.

* Provoost, Veerle et al., "Medical End-of-life Decisions in Neonates and Infants in Flanders", Lancet, Vol. 365 (2005): 1315-1320.

* Mortier, F., L. Deliens, J. Bilsen, M. Cosyns, K. Ingels and R. Vander Stichele, "End-of-life Decisions of Physicians in the City of Hasselt (Flanders, Belgium)," Bioethics, Vol. 14 (July 2000): 254–267.

switzerland

Hurst S.A., and A. Mauron, "Assisted Suicide and Euthanasia in Switzerland: Allowing a Role for Non-physicians," British Medical Journal, Vol. 326 (February 1, 2003): 271–273.

Bosshard, G., S. Fischer and W. Bar, "Open Regulation and Practice in Assisted Dying – How Switzerland Compares with the Netherlands and Oregon," Swiss Medical Weekly, Vol. 132 (October 12, 2002): 527–534.

BIOETHICS AND FREE ESPEECH: The Peter Singer Affair in Germany

Joerden, Jan C., “Peter Singer’s Theories and Their Reception in Germany,” in R. Cohen-Almagor (ed.), Medical Ethics at the Dawn of the 21^st Century (New York: New York Academy of Sciences, 2000): 150-156.

Singer, Peter, “Bioethics and Academic Freedom,” Bioethics, Vol. 4, No. 1 (January 1990), pp. 33-44.