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Ethics

A costly separation between withdrawing and withholding treatment

by Dominic Wilkinson

Television child star Gary Coleman died recently following a severe brain haemorrhage. He was taken to an intensive care unit, but the next day was taken off life support because of the severity of his brain injury.

Decisions like the one made by Gary Coleman’s doctors are common in intensive care. Many deaths follow decisions to stop intensive treatment because it is believed to have no chance of succeeding or because of the burden of illness even if the treatment does work. One question raised about cases like these is about the importance (or risks) of living wills. A separate question (and one that was raised during the critical care grand round earlier today) is about the difference between stopping treatment and failing to start treatment.

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Critical Care ethics grand round

by Dominic Wilkinson

Today I gave a talk at the John Radcliffe Medical Grand Round on Advance Directives and treatment withdrawal decisions in intensive care – based on a case I was involved in last year.

A middle-aged patient presents with acute respiratory failure, and is intubated and transferred to the intensive care unit. After admission he improves, but it transpires that he has a progressive neurodegenerative disorder and has previously expressed a wish not to have intensive life support measures provided.

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Whether to die, or when to die? The distinction between assisted suicide and ‘aid in dying’

Assisted suicide is illegal in the state of Connecticut. But two doctors have sought to circumvent the law by requesting that the administration of lethal agents to terminally ill patients be classed as “aid in dying” rather than assisted suicide. The doctors’ lawyers reportedly drew the distinction as follows:

"Suicide is a choice of whether to die or not. Aid in dying involves not whether a person will die, but when, and how much pain and suffering the patient must endure first."

The judge, Julia Aurigemma, rejected the request, arguing that the cases in question are precisely the sort of case to which the assisted suicide prohibition was intended to apply. But the question remains whether there is a meaningful distinction between assisted suicide and aid in dying, and if so, whether it is morally significant.

The distinction, as formulated by the lawyers, does seem clearly bogus. No-one yet faces choices about whether to die. All actions that might plausibly be classed as suicide are really decisions about the timing of death. But there does seem to be a genuine distinction lurking here somewhere.

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Torture, but do no harm

After the September 11 terrorist attacks, the Bush administration redefined acts that were previously recognised as torture and thus illegal as ‘enhanced interrogation techniques’ (EITs). From then on subjecting detainees to, for example, forced nudity, sleep deprivation, waterboarding and exposure to extreme temperatures could be legal. The line between torture and EITs is a fine one: the classification depends on the level of pain experienced.  

A report issued by the advocacy group ‘Physicians for Human Rights’ has revealed that to ensure that the aggressive interrogation practices conducted by the CIA qualified as EITs they were monitored by doctors and other medical personnel who guaranteed that the legal threshold for  ‘severe physical and mental pain’ was not crossed (NY Times, 6 June 2010).

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A Sting for Absolutes

Sam Harris can sting. Well known for his sharp criticisms of religion, this social gadfly has picked a new target: moral philosophy. His recent TED talk and later articles about the science of morality (here and here) have caused a bit of a ruckus in philosophical circles as well as a feisty response from the general public. His main claim is simple enough: science can give us answers to moral questions. Not just inform our moral judgments or help us get what we want out of life, but actually tell us what we ought to value. In his words, values are a certain kind of fact.

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