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PubMed2003

Rights of patients: comparative perspectives from five countries.

Recognition and articulation of patient rights are core issues in the medical jurisprudence of most nations. While the nature of rights in medical care may vary from country to country, reflecting the idiosyncrasies of domestic law and health delivery, there are commonalities in this area of law that cut across borders. This paper presents five case studies in the patient rights area from Malaysia, Ireland, South Africa, Indonesia and the United States, respectively. The case discussions range from ongoing and fundamental concerns over broad patient rights issues, such as access to health care and informed consent, to rights concerns of those suffering from HIV/AIDS, to a novel consideration over ethical and legal issues concerning ownership of infant organs. It is the hope of the authors that individually, and collectively, the cases will provide helpful insights into this core area of medical law.

Acquired Immunodeficiency Syndrome↗
PubMed1992

The effects of a hospital policy and state legislation on resuscitation orders for geriatric patients.

In 1983, The Genesee Hospital, Rochester, NY, enacted a do-not-resuscitate (DNR) policy that was revised in 1988 because of complex state legislation. Using a retrospective chart review, we studied DNR ordering for all patients older than 79 years who died in the hospital during the 6 months before the policy and compared it with two 6-month intervals after the policy and three 6-month intervals after the law. The hospital policy was associated with an increase in explicit ordering of DNR from 21% in 1982 to 76% for the 2 years thereafter. A further nonsignificant increase to 84% was seen in the 3 years after the law. When cardiopulmonary resuscitation (CPR) was ordered, it was performed in 29% before the policy, 56% in the 2 years after, and 92% for the 3 years after the law. We reviewed all CPR attempts for 1988 and found that the overall survival rate for patients older than 79 years was 39% and probably was the result of careful patient selection. Our hospital policy was not adversely affected and may even have been enhanced by the New York State legislation. Despite this progress, we found that less than 25% of decisions about CPR or DNR were the result of informed decision making by patients themselves.

Aged↗
PubMed2002

Euthanasia, virtue ethics and the law.

Following the recent revival of virtue ethics, a number of ethicists have discussed the moral problems surrounding euthanasia by drawing on concepts such as compassion, benevolence, death with dignity, mercy, and by inquiring whether euthanasia is compatible with human flourishing. Most of these writers assert, or simply assume, that their arguments concerning the morality of euthanasia also support their views with regard to legislation. I argue, against these writers, that legislation cannot and should not be based on our moral and religious beliefs concerning whether euthanasia allows a person to die a good death. I then outline an Aristotelian approach to the role of law and government in a good society, according to which the task of the legislator is not to ensure that people actually act virtuously, but is instead to make it possible for them to choose to live (and die) well by ensuring that they have access to the goods that are necessary for flourishing. In the second half of the paper I apply this approach to the question of whether voluntary active euthanasia should be legalised by asking (1) whether euthanasia always deprives people of the necessary conditions for flourishing, and (2) whether the option to request euthanasia is ever necessary for flourishing.

Chronic Disease↗
PubMed1991

In re Browning.

HELD: Prior judicial approval is not required for a surrogate to exercise the state constitutional right of self-determination of a patient who has become incompetent and who, while competent, specifically expressed her wishes regarding medical treatment decisions orally or in writing. The surrogate, in so exercising that right, must satisfy herself that certain requirements are met.

Advance Directives↗
PubMed1991

In re Smerdon.

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Adult↗