Legitimizing the shameful: End-of-life ethics and the political economy of death

Bioethics

Volumn 21, Issue 1, 2007, Pages 23-31

  Epstein, Miran ^a  

^a ST BARTHOLOMEW S HOSPITAL   (United Kingdom)

Author keywords

Burdensome life; Euthanasia; Hegemony; History; Ideology; Political economy; Unspoken argument

Indexed keywords

ARTICLE; BIOETHICS; DEATH; ECONOMIC ASPECT; ECONOMICS; EUTHANASIA; HISTORY; HUMAN; PATIENT ASSESSMENT; PHILOSOPHY; PHYSICIAN; POLITICS; SHAME; SOCIAL BEHAVIOR;

BIOETHICS; GREAT BRITAIN; HOSPICE CARE; HUMANS; POLITICS; RIGHT TO DIE; TERMINAL CARE;

EID: 33845650324     PISSN: 02699702     EISSN: 14678519     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2007.00520.x     Document Type: Article

References (46)

1. T. Brooks. 2004. How He Saved Us All Hundreds of Thousands by Killing Himself. Daily Express 14 January: 8.
2. While the rule of 'double effect' has been confined to such circumstances only, it applies, in fact, to all circumstances where hastening the death of patients seems justified
3. BMA Ethics Department. 2004. Medical Ethics Today: Its Practice and Philosophy. BMJ Books;
4. T. Hope, J. Savulescu & J. Hendrick. 2003. Medical Ethics and Law: The Core Curriculum. Edinburgh: Churchill Livingstone, Elsevier Science.
5. The common assumption that the primary motivations for the Nazi 'Euthanasia' program were non-economic ought to be revisited. True the concept of 'lebensunwürdiges Leben' ('lives unworthy of life') certainly reflected chauvinistic and eugenic values. However, a growing body of evidence suggests that intentions to rid the Nazi war economy of unproductive, resource-consuming, lives were not less decisive. Moreover, the popularity of such values at the time may be attributed in part to the economic depression in Germany after World War I. See K. Binding & A. Hoche. Permitting the Destruction of Unworthy Life: Its Extent and Form. Issues Law Med 1992; 8: 231-265;
6. F. Hinman. Euthanasia. Journal of Neurological and Mental Diseases 1944; 99.
7. See also J. Gardella. The Cost-Effectiveness of Killing: An Overview of Nazi 'Euthanasia'. Medical Sentinel 1999; 4(4): 132-135. Of particular importance are Aly Götz and Susanne Heim's studies on the logic of the Nazi 'Euthanasia' and annihilation programs.
8. In Oregon, such concerns were raised by just one patient in 2000 (4% of all patients who asked for physician-assisted suicide). DHS Oregon Department of Human Services. Physician-Assisted Suicide: Death with Dignity Annual Report 2000. 2000.
9. Richard Lamm, Governor of Colorado. 1997. Quoted by N. Hentoff. A Duty to Die? The Washington Post. 31 May: A19.
10. J. Hardwig. Is There a Duty to Die? Hastings Cent Rep 1997; 27(2): 34-42; p. 34.
11. Death with Dignity Annual Report 2000, op. cit. note 4.
12. See also B. Balch in Duty to Die Emerges in Oregon. The American Center for Law and Justice. 2000.
13. A.E. Buchanan & D.W. Brock. 1989. Deciding for Others - The Ethics of Surrogate Decision Making. Cambridge: Cambridge University Press.
14. R.R. Faden & T.L. Beauchamp. 1986. The History and Theory of Informed Consent. New York and Oxford: Oxford University Press.
15. I. Berlin. 1969. Four Essays on Liberty. London and New York: Oxford University Press.
16. L. Garrett. 2000. Betrayal of Trust: The Collapse of Global Public Health. New York: Hyperion.
17. R. v Cambridge Health Authority, ex p B. 1995. 25 BMLR 5.
18. It is not disability in itself that strips these patients of their dignity but rather a health care environment that denies them access to appropriate care and treatment. . . . Instead of helping these patients, we are validating their despair. . . . The court said that David was competent to refuse life-sustaining treatment. The real tragedy, however, is that noone gave him the option to live. . . . Patients are rarely suicidal if their needs are met. . . . If we want to help, why do we not ensure that Americans, regardless of income, have access to quality care?' Plight of Disabled Overlooked in Assisted-Suicide Debate. Medical Ethics Advisor, American Health Consultants® 1997; 13(5): 49-51.
19. V. Machin. 2003. Medicolegal Pocketbook. Edinburgh and London: Churchill Livingstone.
20. D.P. Sulmasy et al. Physician Resource Use and Willingness to Participate in Assisted Suicide. Arch Intern Med 1998; 158(9): 974-978.
21. W. Eagle. Quoted in J. Collison. Just a Human Weed? Grandpa! Grandpa! New Oxford Review April 1999: 23-25.
22. The Harvard Report, for instance, gave two rationales for the need to re-define death: allowing permanently unconscious patients to die and designating the permanently unconscious as dead for the purpose of removing organs for transplant. For the history of the definition of death, see A.R. Jonsen. 1998. The Birth of Bioethics. New York and Oxford: Oxford University Press: 235-244.
23. M. Cheung, L. Morrison & P.R. Verbeek. Prehospital Emergency Department Pronouncement of Death: A Cost Analysis. Canadian Journal of Emergency Medicine 2001; 3(3): 177-181.
24. W. Shelton. A Broader. Look at Medical Futility. Theor Med Bioeth 1998; 19: 383-400; p. 398.
25. See also N.S. Jecker & L.J. Schneiderman. Futility and Rationing. Am J Med 1992; 92: 189-195.
26. H.T. Engelhardt, Jr. Rethinking Concepts of Futility in Critical Care. 1996. Available at http://www.mediscene.com/medpub/futile.htm [Accessed 12 September 2006].
27. J.K. Mason & R.A. McCall Smith. 1999. Law and Medical Ethics (Fifth Ed.). London. Butterworths: 379.
28. Hope et al. Law and Medical Ethics (Fifth Ed.). op. cit. note 2: 169.
29. See also D.J. Murphy. The Economics of Futile Interventions. In M.B. Zucker & H.D. Zucker (eds.). 1997. Medical Futility and the Evaluation of Life-Sustaining Interventions. Cambridge: Cambridge University Press: 123-135.
30. Arthur D. Little. International Czech Report. Nov. 28, 2000. Produced for Phillip Morris.
31. Mason and McCall Smith. International Czech Report. op. cit. note 21: 292.
32. See also G.S. Robertson. Dealing With the Brain-damaged Old - Dignity Before Sanctity. J Med Ethics 1982; 8: 173.
33. J. Harris. QALYfying the Value of Life. J Med Ethics 1987; 13: 117-119.
34. One exception was that idea of DALYs advocated by the World Bank in the early 1990s. In this case, Third World countries were offered loans by the Bank on the explicit condition that they restructured their collapsing health care systems in a way that implied an increase of their GDP, and consequently - an increase of the repayment capacity of external debts. World Bank. 1993. World Development Report 1993: Investing in Health. Oxford: Oxford University Press.
35. Mason & McCall Smith. World Development Report 1993: Investing in Health. op. cit. note 21: 412.
36. E.J. Emanuel & L.L. Emanuel. The Economics of Dying. N Engl J Med 1994; 340: 540-544.
37. C.M. Watts. A New Ethic for Medicine and Society. Calif Med 1970; 113: 67-68.
38. R. Dubos. Opening Assembly, from the Dartmouth Convocation on Great Issues of Conscience in Modern Medicine, September 8-10, 1960. Dartmouth Alumni Magazine 1960; 53(2): 8-9.
39. D. Humphry & M. Clement. 1998. Freedom to Die: People, Politics and the Right-to-Die Movement. New York: St. Martin's Press: 333.
40. R. Woodruff. 1999. Euthanasia and Physician-Assisted Suicide - Are They Clinically Necessary? International Association for Hospice and Palliative Care. Available at http://hospicecare.com/Ethics/RWethics1.htm [Accessed 12 September 2006].
41. M. Warnock. Some Moral Problems in Medicine. Health Econ 1994; 3: 297-300.
42. Humphry & Clement. Health Econ op. cit. note 31.
43. 'It could have taken another week before she died; I just needed this bed' [A Dutch doctor accused of homicide]. Quoted in G. van der Wal et al. Evaluation of the Notification Procedure for Physician-Assisted Death in the Netherlands. N Engl J Med 1996; 335: 1706-1711.
44. See also R.G. Twycross. Euthanasia: Going Dutch? J R Soc Med 1996; 89: 61-63;
45. H. Hendin. 1997. Seduced by Death. New York: WW Norton.
46. A. Gramsci. 1971 [1929-1935]. Selection from the Prison Notebooks. Q. Hoare & G. Nowell Smith (eds.). London: Lawrence & Wishart; New York: International.