JAMA Netw Open. 2019;2(8):e198628. doi:10.1001/jamanetworkopen.2019.8628
Daniel P. Sulmasy
Al Rabadi et al1 compare statistics on physician-assisted suicide (PAS) available from public databases for the states of Washington and Oregon and find similar profiles and trends, which is unsurprising given the similarity of the laws and demographic characteristics of these states. Among the unanswered questions are what such a study can contribute to medical ethics (about PAS or any other ethical controversy) and what the limits are of such work.
First, it should be noted that the medical literature is, in general, favorably disposed toward the empirical and the new. Although this predilection is often advantageous for scientific progress, it introduces a problematic bias when applied to ethical questions. The appeal of the study by Al Rabadi et al1 is that it is empirical, and by comparing data from 2 states for the first time, it can be considered novel. Because there are new reports each year and the practice of PAS is legal in only a few states, descriptive reports about PAS are published frequently. This means, however, that articles defending the ethical status quo (ie, against PAS) tend to be shut out of the medical literature because they are not reporting anything new and, therefore, cannot have any data. The result is an impression of growing acceptance of PAS, but it really represents an artifact of a scientific bias. . . . [Full text]
New York Law Journal
A U.S. Department of Health and Human Services proposed rule that would more vigorously protect health care providers’ ability to deny coverage in certain circumstances because of moral or religious beliefs should be withdrawn, according to a coalition of state attorneys general.
The proposed rule would strengthen the enforcement of existing regulations that allow providers to invoke conscientious objections as a basis for refusing to provide care that involves certain medical issues, including abortion, sterilization, assisted suicide and others. It also would allow individual providers to object to informing patients about their medical options or referring them to providers of those options. . . [Full Text]
The American Civil Liberties Union (ACLU) is suing a Washington state public hospital district, claiming that it is failing to provide medical and surgical abortions. In fact, the hospital district provides both, but refers patients to other facilities for abortion when they cannot be provided in one of the district hospitals because of conscientious objection to the procedure by staff. It thus appears that the ACLU is not content with forcing facilities to refer for abortion, but intends to force them to provide the procedure despite conscientious objection by physicians and health care workers. [Reuters]
In one of the last photographs my family took of my grandmother, she looks as if she’s been in a fistfight. Jean Bass Tinsley is lying in a hospital bed in Athens, Georgia, wearing a turquoise button-up shirt and staring blankly at the camera. A bandage obscures her fractured skull, along with the bridge of her bloodied nose. She is 91 years old.
My grandmother essentially did this to herself. In June 2013, she fell out of her wheelchair headfirst, after ignoring her caregivers’ warnings not to get out of bed without help. Earlier that year, she’d broken both of her hips, in separate falls. Before that, her pelvis-all while trying to do what for most of her life she’d managed just fine on her own: walk.
In her last year, dementia crept into my grandmother’s mind. The staff at her long-term-care facility plotted ways to protect her from herself. It’s against the law in Georgia to restrain patients in such facilities, so they lowered her bed to the floor and put a pad down next to it. They even installed an alarm that went off if she left her mattress. My grandmother disabled the alarm, moved the pad and freed herself, repeatedly. In the end, she was both too weak and too strong. [Full text]
The Washington State Department of Health has posted a web page that lists all of the hospitals in the state, together with their policies on admission, non-discrimination, end of life care, and reproductive health care. The page makes it possible for those seeking morally contested procedures to locate hospitals willing to provide them, while allowing hospitals that do not provide them to provide notice of that fact. This should help to minimize inconvenience and conflict.