Autonomy,life as an intrinsic value,and the right to die in dignity

This paper examines two models of thinking relating to the issue of the right to die in dignity: one takes into consideration the rights and interests of the individual; the other supposes that human life is inherently valuable. I contend that preference should be given to the first model, and further assert that the second model may be justified in moral terms only as long as it does not resort to paternalism. The view that holds that certain patients are not able to comprehend their own interests in a fully rational manner, and therefore ‘we’ know what is good for these patients better than ‘they’ do, is morally unjustifiable. I proceed by refuting the ‘quality of life’ argument, asserting that each person is entitled to decide for herself when it is worth living and when it is not. In this connection, a caveat will be made regarding the role of the family. The author’s research interests include bioethics, free speech, tolerance and ethics in the media.     

Right to life, right to die and assisted suicide

In 2002 Diane Pretty went to the European Court of Human Rights to gain a ruling about assisted suicide. In the course of this she argued that the right to life implied a right to die. This paper will consider, from an ethical rather than a legal point of view, how the right to life might imply (or not) a right to die, and whether this includes either a right that others shall help us die, or a right against non-interference if others are willing to help us. It does this by comparing the right to life to conceptions of property rights. This is not because I think human life is property, but because some of our ways of talking and thinking about our control over our own lives seem to be similar to our thoughts about our control over our own property. The right to life has traditionally been taken as a negative right, that is a right that others not deprive us of life. Pretty's argument, however, seems to be moving towards a positive right, not just to remain alive, but to be enabled in doing what we want to with our lives, and thus disposing of them if we so choose. The comparison with property rights suggests that the right to die only applies if our lives are ours absolutely, and may itself be modified by the suggestion that suicide harms all of us by devaluing human life in general.     

Trust,autonomy, and advance directives

Trust has been largely ignored in contemporary bioethical discussions and also by courts of law. The favored language of autonomy, privacy, and rights is useful but insufficient to speak to moral experience, especially the experience of persons who write advance directives, but also physicians who receive such directives. The Brophy case is analyzed for its salient features, and a more central place for the concept of trust is proposed.This paper was presented at the Lehigh Valley Hospital Center Conference, Making Medical Decisions with and for Patients in Difficult Medical Circumstances, in 1988.The author has profited greatly in writing this paper from reading Nancy King'sMaking Sense of Advance Directives, to be published by D. Reidel, Dordrecht, The Netherlands.     

Legal implications for failure to comply with advance directives: an examination of the incompetent individual's right to refuse life-sustaining medical treatment

Life-sustaining medical technology in the past century has created a growing body of case law and legislation recognizing the incompetent individual's right to make his or her own end-of-life decisions. This article focuses on California's leadership in the area of these specific end-of-life issues: specifically, exploring the right of an incompetent individual to refuse life-sustaining medical treatment. The article examines advance directives along with various judicial decision-making standards for incompetent individuals and explores the sociobehavioral and legal rationale for compliance with incompetent individual's rights to make end-of-life decisions. Finally this article concludes (i) that advance directives allow competent individuals to state the medical treatment they would prefer in the event they should later become incompetent and (ii) that when advance directives are properly executed in a detailed manner, under laws currently in effect in some jurisdictions, the preferences stated in the directive bind health care providers.     

The right to die at the end of your life

The Missouri case of Nancy Cruzan brings into sharp focus the medical ethics issue of the right to privacy. It also raises the need for definition of life ranging from cellular to personal. What is it about forced feeding that transforms it into an extraordinary means of nonfunctional treatment? There is the question of balancing benefit and cost (whether personal or financial). Currently we are confronted by the problem of balancing human rights violations against efforts to be “helpful” by the use of heroic medical measures, all of this against the background of ever-changing medical technology.     

Persistent vegetative state, prospective thinking, and advance directives

This article begins with a discussion of persistent vegetative state (PVS), focusing on concerns related to both diagnosis and prognosis and paying special attention to the 1994 Multi-Society Task Force report on the medical aspects of PVS. The article explores the impact of diagnostic and prognostic uncertainties on prospective thinking regarding the possibility of PVS and considers the closely related question of how prospective thinkers might craft advance directives in order to deal most effectively with this possibility.     

Some reflections on the problem of advance directives, personhood, and personal identity

In this paper, I consider objections to advance directives based on the claim that there is a discontinuity of interests, and of personal identity, between the time a person executes an advance directive and the time when the patient has become severely demented. Focusing narrowly on refusals of life-sustaining treatment for severely demented patients, I argue that acceptance of the psychological view of personal identity does not entail that treatment refusals should be overriden. Although severely demented patients are morally considerable beings, and must be kept comfortable whilst alive, they no longer have an interest in receiving life-sustaining treatment.     

Eudaimonia and well-being: questioning the moral authority of advance directives in dementia

Theoretical Medicine and Bioethics - This paper revisits Ronald Dworkin’s influential position that a person’s advance directive for future health care and medical treatment retains its...     

A multigenerational study on the correlation of values and advance directives

The development of the Values History instrument for use in advance directive decision making has raised the question of the importance of values in eliciting advance directives. This pilot study examines the relationship between the domains of values and advance directives drawn from the Values History in three generation intrafamily triads. Significant correlations between values and advance directives were found primarily within the youngest generation. Results reveal a relatively high familiarity by the participants of the various established forms of advance directives. Also, a significant percentage of parents and grandparents was found to have signed some form of advance directive.