This commentary examines the ethics and law in the United States as they relate to the foregoing of life sustaining treatment when such treatment is deemed medically inappropriate. In particular the article highlights the procedural approach when there is disagreement between physicians and surrogates or patients as exemplified in Texas Law. This approach, although worthy in concept, may in practice invite opposition and dissatisfaction as it may be perceived as coercive and pitting the weak against powerful adversaries and interests, in (...) addition to discouraging the exercise of professional virtues. Too inflexible an approach erodes trust, and furthermore the Texas law allows hospital ethics committees to move from an advisory non judgmental role to a quasi legal court with real legal power but no credentialing or oversight. (shrink)

Trust is essential in human relationships including those within healthcare. Recent studies have raised concerns about patients’ declining levels of trust. This article will explore the role of trust in decision-making about cardiopulmonary resuscitation (CPR). In this research thirty-three senior doctors, junior doctors and division 1 nurses were interviewed about how decisions are made about providing CPR. Analysis of these interviews identified lack of trust as one cause for poor understanding of treatment decisions and lack of acceptance of medical judgement. (...) Two key implications emerged from the analysis. First, before embarking on a discussion about CPR it is essential to establish trust between the doctor and the patient/family. Secondly, it is essential that the CPR discussion itself does not undermine trust and cause harm to the patient. (shrink)

This paper provides a reflective analysis of the nature of normative critiques of law generally, and within medical law specifically. It first seeks to establish the context within which critical analysis of law and legal measures takes place, and develops an argument that critiques should focus on political norms. Entailed in this claim is the contention that positions that seek to address controversial social problems can not resort simply to moral philosophy. It then provides a brief account of political liberalism (...) that can contain and expose normative constraints on questions of moral and social contention. The focus then moves to a more direct reflection on medico-legal analysis. Considering both medical law as a discipline, and the study of end-of-life issues, the argument highlights the range of relevant issues that must be accounted for, and addresses the question of whether these are well conceived as ones of medical law. It is argued that a political framing offers a good general analytic context, but that when working in legal sub-disciplines analysts risk allowing 'locally' pertinent norms to dominate or unduly constrain wider debate. Thus it is questioned whether 'medical law' provides a coherent frame for social questions related to assisted-dying. (shrink)