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Unilateral withholding and withdrawal of potentially life-sustaining treatment: a violation of dignity under the law in Canada.

In this paper, I review Canadian law in relation to the unilateral withholding or withdrawal of potentially life-sustaining treatment, and I look at such questions as whether physicians are legally permitted to unilaterally put a do-not-resuscitate (DNR) order on a patient's chart. I explore who has the legal authority in Canada to decide on withholding and withdrawal of potentially life-sustaining treatment, and I conclude that unilateral withholding and withdrawal is a violation of the strong social commitment to dignity as it is understood and reflected in the law by the Supreme Court of Canada. I then offer a concrete proposal for institutional policy with respect to unilateral withholding and withdrawal of treatment in light of the law.

Advance Directives↗

Oregon: does physician-assisted suicide work?

Since November 1997, Oregon, a State in the United States of approximately 3.3 million people, has allowed physician-assisted suicide, although not euthanasia, by virtue of the Death with Dignity Act. Before the Act, physician-assisted suicide, as in Australia and other common law jurisdictions, was illegal. Under the Act, the Oregon Department of Human Services is required to collect information and provide an annual report. The Sixth Annual Report on Oregon's Death with Dignity Act was released on 10 March 2004.

Attitude of Health Personnel↗

Genetic research & human biological samples: some legal and ethical considerations.

This paper examines the medico-legal and medico-ethical issues that ethics committees and researchers will have to consider when examining proposals pertaining to non-therapeutic genetic research. This paper is limited to the examination of issues that relate to those individuals who donate bodily/DNA samples for the purposes of non-therapeutic genetic research. The issues that arise are those of (i) informed consent and those with diminished capacity (ii) the drafting of consent forms as they relate to genetic research (iii) confidentiality, genetic research with non-EU countries and the implications of the EC Directive on the Protection of Data: 95/46/EC and (iv) an examination of international ethical guidelines. The paper concludes with (i) a summary of the main points of concern that ethics committees must consider before the approval of genetic research (ii) the manner in which consent forms must be drafted and (iii) a brief look at medico-legal issues that will become important and will have to be considered in Ireland in the near future in relation to genetic research.

Confidentiality↗

Living wills and advance directives in South African Law.

The legal status of living wills and advance directives in South African Law will be considered. Presently there is no reported judgment of a court in South Africa which has directly ruled on the validity of an advance directive or living will. In a case decided in 1992 the issue as to whether to discontinue life supporting treatment was decided with reference to the legal persuasions of society and whether, in light of these, it would be reasonable to discontinue artificial feeding of the patient. The judge indicated that just as a living person has an interest in the disposal of his body so did he think that the patient's wishes as expressed when he was in good health should be given effect. In South African law every person is legally entitled to refuse medical treatment even if the consequences may be to hasten death. The South African Law Convention has extensively investigated the issue in its report entitled Report on Euthanasia and the Artificial Preservation of Life in 1998. Certain problems were identified and a draft bill was suggested.

Advance Directives↗

Pharmacist misconduct: the pitfalls of practice.

This article identifies the changing role of pharmacists in the provision of health care and analyses 78 complaints against pharmacists over a recent 12-year period in New South Wales, finding that the majority of complaints were in relation to the oversupply of particular medications, from which some pharmacists made significant financial gains. A number of other areas of complaint were identified, including issues in relation to the recording and labelling of medications and the roles and responsibilities of pharmacists, dispensing errors, fraud, and sexual misconduct. As the roles of pharmacists continue to expand, with the growth of "compounding chemists", and the suggestion that pharmacists are now performing basic medical tasks which were once the domain of a general practitioner, it is increasingly important that pharmacy take its place in any debates about the provision and regulation of health services.

Community Participation↗

HCA, Inc. v. Miller.

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Advance Directive Adherence↗