Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma in patient care, you vote, and then we present an expert's judgment.
Last week, you voted on whether or not to euthanize a resistant dementia patient. Here are the results from more than 5,100 votes:
Do you proceed with the lethal injection?
Yes: 750
No: 4,440
Does your answer change if the patient wrote a subsequent letter, effectively nullifying her original instructions?
Yes: 1,359
No: 3,770
Do you consult with the patient's medical power of attorney?
Yes: 3,908
No: 1,266
And now, Gregory Dolin, MD, JD, weighs in:
Generally speaking, euthanasia is prohibited in every state in the country (including those that permit physician-assisted suicide). Thus, to the extent that the physician (or the family) is contemplating taking active, affirmative steps to bring about the patient's death, such action would likely result in criminal charges for homicide -- whether the charge is murder, manslaughter, or something else would depend on the state and the prosecutor.
If, on the other hand, the physician is contemplating assisting the patient in suicide, that might change the analysis depending on whether the event is occurring in a state where physician-assisted suicide is permitted or prohibited. But, on the facts of this case, it does not appear that the patient is interested in suicide, thus making the physician's willingness to participate rather moot.
Although it may well be that it is the patient's earlier statements that express her true desires -- rather than the present ones that are affected by her dementia -- the physician would not be permitted to accede to those wishes whether or not she was lucid.
is associate professor of law and co-director, Center for Medicine and Law at the University of Baltimore, where he also studies biopharmaceutical patent law. His work includes a number of scholarly articles, presentations, amicus briefs, and congressional testimony.
And check out some of our past Ethics Consult cases: 'Freeze' Little Girl in 6-Year-Old Body?, Deaf Couple Only Wants Deaf Baby, and Critical Patient With DNR Tattoo.