South Korea's Supreme Court has upheld a landmark ruling giving a brain-dead woman the right to die. The court agreed to a request from the family of the 76-year-old woman, who has been comatose for a year, to remove her from life support.
Van den Block and colleagues’ paper about end of life decision making and end of life care provides important data to support the debate about physicians’ role in death and dying. Their finding that end-of-life decision making seems to be associated with a high use of palliative care is not surprising, because a protracted dying process with much suffering may be expected to result in both a high use of palliative care and a high frequency of end-of-life decisions, especially for assertive patients with clear preferences concerning the end stage of their lives. More importantly, the study’s results suggest that palliative care is not able to prevent physicians and patients from making medical decisions that hasten death. This may be due to insufficient quality, that should be further improved, but it may also be indicative of principal limitations of palliative care, that apparently cannot address all suffering at the end of life.
More than 700,000 people in the UK currently suffer from dementia, and nearly 500,000 friends and family members act as carers for people with dementia. Our rapidly ageing population means that these numbers are likely to double in the next forty years. While we are getting to understand better the causes of the disease, and diagnostic and treatment options are improving, we are still a long way from prevention or cure. Meanwhile, these people and their families, healthcare staff and care workers face difficult ethical dilemmas on a day-to-day basis. An exploratory workshop was held in March 2007, and the Nuffield Council set up a Working Party in December 2007 to examine the ethical issues raised by dementia. Following a public consultation and meetings with stakeholders including people with dementia, carers, health professionals and other members of the public, a report with recommendations for policy makers was published on 1st October 2009.
A national survey of 3733 UK doctors reporting on the care of 2923 people who had died under their care is reported here. Results show that there was no time to make an ‘end-of-life decision’ (deciding to provide, withdraw or withhold treatment) for 8.5% of those reporting deaths. A further 55.2% reported decisions which they estimated would not hasten death and 28.9% reported decisions they had expected to hasten death. A further 7.4% reported deaths where they had to some degree intended to hasten death. Where patients or someone else had made a request for a hastened death, doctors were more likely to report expecting or at least partly intending to hasten death. Doctors usually made these decisions in consultation with colleagues, relatives and, where feasible, with patients.
Around a third of doctors say they have given drugs to terminally ill patients or withdrawn treatment, knowing or intending that it would shorten their life. A study of doctors in charge of the last hours of almost 3,000 people finds decisions almost always have to be made on whether to give drugs to relieve pain that could shorten life and whether to continue resuscitation and artificial feeding. In 211 cases (7.4%), doctors say they gave drugs or stopped treatment to speed the patient's death. In 825 cases (28.9%), doctors made a decision on treatment that they knew would probably or certainly hasten death. One in 10 patients asked their doctor to help them die faster. What doctors do varies according to their religious beliefs, according to Prof Clive Seale, who carried out the research. But, he said, there was no evidence of a "slippery slope": that deaths of the most vulnerable, such as very elderly women and those with dementia, are being hastened more than others.
Politically strident debates surrounding end-of-life decisionmaking have surfaced once again, this time across the Atlantic in Italy. Eluana Englaro died early this year after a prolonged court fight, causing the international press to compare her case to that of Theresa Marie Schiavo, who passed away in 2005 in Florida after nearly sparking constitutional crises on both state and federal levels. In many respects, the facts of Ms. Englaro’s case are similar to Schiavo, but a close analysis of Englaro leads to the surprising conclusion that the Italian Court of Cassazione in that case actually enunciated a broader, stronger right to make end-of-life decisions than has the United States Supreme Court thus far in America.
A father is fighting a hospital's attempt to withdraw support keeping his baby son alive. The one-year-old, known as Baby RB for legal reasons, was born with a rare, genetic muscle condition that makes it hard for him to breathe independently. His parents are going to the High Court - the mother is reportedly supporting the hospital's bid. The father's lawyers argue that the boy's brain is unaffected, meaning he can see, hear, interact and play. Despite having to remain in hospital and being dependent on a ventilator to breathe, he enjoys having stories read to him and listening to music, they say. The lawyers are submitting video footage to the court, which they say shows him playing with his toys. But the hospital says that Baby RB's quality of life is so low that it would not be in his best interests to try to save him. Baby RB was born with congenital myasthenic syndrome and has been in hospital since birth.
A father whose son was born with a rare neuromuscular condition will go to the high court tomorrow in an attempt to stop a hospital withdrawing the support that keeps the child alive. Doctors treating the one-year-old say the boy's quality of life is so poor that it would not be in his best interests to save him. They are reportedly being supported in their action by the baby's mother, who is separated from his father. The child, known for legal reasons as Baby RB, was born with congenital myasthenic syndrome (CMS), a muscle condition that severely limits movement and the ability to breathe independently. He has been in hospital since birth. If the hospital succeeds in its application, it will be the first time a British court has gone against the wishes of a parent and ruled that life support can be discontinued or withdrawn from a child who does not have brain damage.
A one-year-old boy at the centre of a "right-to-life" legal dispute would not benefit from an operation to help him breathe, the High Court has been told. The child, known as Baby RB, has a rare, genetic condition that makes it hard for him to breathe independently. But a leading paediatrician, known as Dr F, said he was "not a candidate" for surgery to try to open up his airway. Baby RB's father is fighting a hospital's attempt - backed by the mother - to withdraw his life support.
A doctor has agreed a baby in a "right-to-life" legal row may be able to interact - but any mental development would only make his fate more tragic. The paediatric neurologist told the High Court the severely disabled child, Baby RB, would remain in a "no chance" situation even if he developed further. He questioned the life the boy would lead if he was capable of cognitive function but physically so disabled.
Subsequent to an intensive three-year period of reflection, the CMQ is revealing its perspective and conclusions today regarding end-of-life care and euthanasia. The CMQ embraces the point of view of the patient who is confronting imminent and inevitable death. In such a situation, the patient looks to their physician and generally requests that they be able to die without undue suffering and with dignity. Neither surveys, nor attorneys, nor politicians can properly advise the physician and the patient facing this situation. In the majority of cases, the patient and their doctor find the appropriate analgesia that respects the ethical obligation of physicians not to preserve life at any cost, but rather, when the death of a patient appears to be inevitable, to act so that it occurs with dignity and to ensure that the patient obtains the appropriate support and relief.
A doctor has said that a baby in a "right-to-life" legal row has the potential to communicate and even operate a wheelchair in years to come. The paediatric neurologist, Professor Fenella Kirkham, told the High Court that Baby RB had the normal intelligence of a one-year-old. She said he was likely to develop language recognition skills and he may be better off at home. The boy's father is fighting an attempt by the hospital to end life support.
A father who had been fighting to stop a hospital withdrawing life support from his seriously ill son has dropped his objections. The one-year-old, known as Baby RB for legal reasons, was born with a rare, genetic muscle condition that makes it hard for him to breathe independently. The hospital was backed by the baby's mother. But the move had been strongly opposed by the child's father at a High Court hearing. However, the father changed his mind after hearing medical evidence which suggested it would be in the best interests of the child if medical support was withdrawn. Lawyers for the health authority caring for the baby in intensive care told Mr Justice McFarlane: "All of the parties in court now agree that it would be in RB's best interests for the course suggested by the doctors to be followed."
A father who went to the High Court to try to stop a hospital turning off his seriously ill baby son's life support machine has dropped his objections to the move. The outcome has prompted a mixture of sadness and relief. For six days they had sat in the bland surroundings of Court 50 at London's High Court listening to others talking about their baby son's quality of life. A host of paediatricians, nurses, and experts went into the witness box. Many of them urged a judge to decide that this profoundly disabled 13-month-old boy should be allowed to die. It was, they said, no longer in his best interests to keep him alive.
Objectives: To investigate why physicians label end-of-life acts as either ‘euthanasia/ending of life’ or ‘alleviation of symptoms/palliative or terminal sedation’, and to study the association of such labelling with intended reporting of these acts. Conclusions: Similar cases are not uniformly labelled. However, a physicians’ label is strongly associated with their willingness to report their acts. Differences in how physicians label similar acts impede complete societal control. Further education and debate could enhance the level of agreement about what is physician-assisted dying, and thus should be reported, and what not.