Is Consent Useful When Resuscitation Isn't?

A Do Not Resuscitate order reflects a considered judgment that a physician can no longer stave off death. Why, then, have a patient consent to such an order? The primary point is that physicians should share with patients their judgment about what medicine can and cannot do. Because we cannot make death go away, we must make decisions about when to withhold or limit resuscitation openly, in honest and trusting conversation between doctor and patient.     

When Is a Failure of Imagination Dangerous?

“When Is a Failure of Imagination Dangerous?”: letters from Stephen Kuusisto and Claire Roy about “Comfort Care as Denial of Personhood” (Jul‐Aug 2012), with a reply by William J. Peace; “Ruthless”: a letter from Ruth Macklin about the editor's note to the Mar‐Apr 2012 issue of the Report; and “What Is an Individualist?” a letter from Dena S. Davis about a letter by Eric Cassell in the Nov‐Dec 2011 issue.     

Justified Limits on Refusing Intervention

Physicians may justifiably limit patients' refusals of medical interventions when the refusal is based on a negative right to noninterference coupled with a request for an unreasonable alternative.     

When Is Birth Unfair to the Child?

Has a child been treated unfairly if the only way it can exist is by having an awful life? A principle of parental responsibility can be used to show how the child is wronged.     

Can War Be Justified (and Restrained)?

Book reviewed in this article: Just War Tradition and the Restraint of War: A Moral and Historical Inquiry . By James Turner Johnson.     

When Voluntary Stopping of Eating and Drinking in Advanced Dementia Is No Longer Voluntary

In “On Avoiding Deep Dementia,” Norman Cantor astutely notes that, for some individuals, the concept of “protracted maintenance during progressive cognitive dysfunction and helplessness is an intolerably degrading prospect.” This cannot be argued with. Cantor's solution, however—that in the wake of a dementia diagnosis, patients should have the option to direct, in advance, instructions for voluntary stopping of eating and drinking should they develop a state of deep dementia—is more ethically challenging than it may first appear. Respect for autonomy is one of the most fundamental principles of bioethics, and it requires that we allow patients with capacity to refuse life‐sustaining treatment, even when that treatment is something as seemingly innocuous as nutrition and hydration. If a capacitated person uses an advance directive to prospectively refuse artificial nutrition or hydration, then that treatment must be withheld if the person develops dementia and loses the ability or willingness to eat. Cantor is incorrect, however, in suggesting that an advance directive can require that nutrition and hydration be withheld from a patient with dementia who actively requests to eat or drink. Regardless of the language in an advance directive, caregivers cannot be compelled to abandon their duty to attend to the person's human dignity, nor can physicians be compelled to sedate a person with moderate or severe dementia because that person continues to be receptive to eating and drinking.     

When Public Health Becomes Politicized

Perhaps nothing symbolizes the current polarized political climate in the United States more than the world of public health. Public health schools and health departments are full of “true believers,” people willing to crusade for any program designed to reduce morbidity and mortality. But in the “real world,” proven programs and strategies—such as gun‐control measures, universal vaccination, and improved traffic safety—are routinely thwarted. Why do critics oppose efforts to improve the public's health? History can provide some answers.      

When Information CAN SAVE LIVES

In certain cases of sudden death, forensic experts may discover during an investigation or autopsy that family members of the deceased are also at risk of harm—from genetic disease, for instance. But do they have a duty to warn them? Looking at similar duties of physicians and researchers to warn third parties of risk suggests they do.