A few years ago a battered infant was admitted to a California hospital. After a period of observation and testing, the physicians concluded that the infant had been beaten so badly that his brain was almost completely destroyed, leaving him permanently unconscious. The hospital had just adopted a policy specifying that life-sustaining treatment for permanent unconsciousness was futile and, therefore, not indicated. According to this policy, after suitable subspecialty consultations and deliberations, including efforts to gain parental agreement and documentation of (...) unanimous ethics committee support, the patient's physician had the authority to discontinue life-sustaining treatment. The infant's physician wished to do this. The mother, however, who was the prime battery suspect, insisted that the baby be kept alive. (shrink)
The modern history of experimentation with human beings is notable for its ethical lacunae. In 1865, in his great work, An Introduction to the Study of Experimental Medicine, Dr. Claude Bernard, the French physician who first established the use of the scientific method in medicine, echoed the earlier injunctions of physician-moralist Moses Maimonides in counseling his fellow physicians not to treat their patients solely as a means of advancing knowledge. Yet such cautions had no apparent effect on the physicians who, (...) at the end of the 19th century, studied the transmission of venereal diseases by intentionally infecting poor and institutionalized people without their knowledge, much less their consent. In response... (shrink)
In 1990, I voiced strong doubts about a bill entitled the Patient Self-Determination Act, which had been introduced in the U.S. Senate by John Danforth and Daniel Patrick Moynihan. I hoped to see it defeated. In 1991, after the bill had become a small part of a massive status adopted in the waning hours of the 101st Congress, I devoted countless hours to its implementation. I wanted to see it succeed. Why the change?