Disability rights advocates have expressed significant concern about the potential dangers assisted suicide poses for persons with disabilities. This article extends this examination of concerns to withholding and withdrawing treatment in general and, in the specific case of physicians, using the futility rationale to discontinue or not start treatment. The arguments set forth against assisted suicide are applied to withholding and withdrawing treatment and futility and are shown to be at least as applicable to these other forms of hastening death. The article concludes with some policy suggestions.
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References
1.
Alpers, A., & Lo, B. (1995). When is CPR futile? Journal of theAmerican Medical Association, 273, 156—158.
2.
Asch, D.A., Hansen-Flaschen, J., & Lanken, P.N. (1995). Decisions to limit or continue life-sustaining treatment by critical care physicians in the United States: Conflicts between physicians' practices and patients' wishes. American Journal of Respiratory and Critical Care Medicine,151, 288—292.
3.
Bascom, P.B., & Tolle, S.W. (2002). Responding to requests for physician-assisted suicide: “These are uncharted waters for both of us….” Journal of theAmerican Medical Association, 288, 91—98.
4.
Batavia, A.I. (1997). Disability and physician-assisted suicide. The New England Journal of Medicine, 336, 1671—1673.
5.
Batavia, A.I. (2000). The relevance of data on physicians and disability on the right to assisted suicide: Can empirical studies resolve the issue?Psychology, Public Policy, and Law,6, 546—558.
6.
Batavia, A.I. (2002). Disability versus futility in rationing health care services: Defining medical futility based on permanent unconsciousness—PVS, coma, and anencephaly. Behavioral Sciences & the Law, 20, 219—233.
7.
Battin, M. P., Rhodes, R., & Silvers, A. (Eds.). (1998). Physician assisted suicide: Expanding the debate . New York: Routledge.
8.
Bay Area Network of Ethics Committees. (1999 ). Nonbeneficial or futile medical treatment: Conflict resolution guidelines for the San Francisco Bay Area. The Western Journal of Medicine, 170, 287—290.
9.
Berger, J.T. (1998). Culture and ethnicity in clinical care. Archives ofInternal Medicine, 158, 2085—2090.
10.
Bhopal, R. (1998). Spectre of racism in health and health care: Lessons from history and the United States. British Medical Journal , 316, 1970—1973.
11.
Bickenbach, J.E. (1998). Disability and life-ending decisions. In M. P. Battin, R. Rhodes, & A. Silvers (Eds.), Physician-assisted suicide: Expanding the debate (pp. 123—132). New York: Routledge.
12.
Brief of Amici Curiae Not Dead Yet et al. ( 2003). In re guardianship of Theresa Marie Schiavo, incapacitated . Retrieved December 15, 2003, from http://www.notdeadyet.org/docs/schaivobrief.html
13.
Coleman, D. (1992). Withdrawing life-sustaining treatment from people with severe disabilities who request it: Equal protection considerations. Issues in Law &Medicine, 8, 55—79.
14.
Coleman, D. (2002). Not dead yet. In K. Foley & H. Hendin (Eds.), The case against assisted suicide: For the right to end-of-life care (pp. 213—237). Baltimore: Johns Hopkins University Press.
15.
Council on Ethical and Judicial Affairs, American Medical Association. (1992). Decisions near the end of life. Journal of the American Medical Association, 267, 2229—2233.
16.
Crossley, M.A. (1995). Medical futility and disability discrimination . Iowa Law Review, 81, 179—259.
17.
Curtis, J.R., Park, D.R., Krone, M.R., & Pearlman, R.A. (1995). Use of the medical futility rationale in do-not-attempt-resuscitation orders. Journal of theAmerican Medical Association, 273, 124—128.
18.
Field, M. J., & Cassel, C. K. (Eds.). (1997). Approaching death: Improving care at the end of life. Washington, DC: National Academy Press.
19.
Fiscella, K., Franks, P., Gold, M.R., & Clancy, C.M. (2000). Inequality in quality: Addressing socioeconomic, racial, and ethnic disparities in health care. Journal of theAmerican Medical Association, 283, 2579—2584.
20.
Freeborne, N., Lynn, J., & Desbiens, N.A. (2000). Insights about dying from the SUPPORT Project. Journal of the American Geriatrics Society , 48, S199—S205.
21.
Gill, C.J. (1992). Suicide intervention for people with disabilities: A lesson in inequality. Issues in Law &Medicine, 8, 37—53.
22.
Gill, C.J. (1999). The false autonomy of forced choice: Rationalizing suicide for persons with disabilities. In J. L. Werth, Jr. (Ed.), Contemporary perspectives on rational suicide (pp. 171—180). Philadelphia: Brunner/Mazel .
23.
Gill, C.J. (2000). Health professionals, disability, and assisted suicide: An examination of relevant empirical evidence and reply to Batavia (2000). Psychology, Public Policy, and Law,6, 526—545.
24.
Halevy, A., & Brody, B.A. (1996). A multi-institution collaborative policy on medical futility. Journal of the American MedicalAssociation, 276, 571—574.
25.
Helft, P.R., Siegler, M., & Lantos, J. (2000). The rise and fall of the futility movement. The New England Journal of Medicine, 343, 293—296.
26.
Herr, S.S., Bostrom, B.A., & Barton, R.S. (1992). No place to go: Refusal of life-sustaining treatment by competent persons with physical disabilities. Issues in Law & Medicine, 8, 3—36.
27.
Hudson, T. (1994, February 20). Are futile-care policies the answer?Hospitals & Health Networks, pp. 26—32.
28.
Hwang, K. (1999). Rational suicide and the disabled individual: Self-determination versus social protection. In J. L. Werth, Jr. (Ed.), Contemporary perspectives on rational suicide (pp. 181—187). Philadelphia: Brunner/Mazel .
29.
In re L.W., 482 N.W.2d 60 (Wis. 1992).
30.
Jecker, N.S. (1995). Medical futility and care of dying patients. The Western Journal of Medicine, 163, 287—291.
31.
Jecker, N.S., & Schneiderman, L.J. (1992). Futility and rationing . The American Journal of Medicine, 92, 189—196.
32.
Kirschner, K.L., Gill, C.J., & Cassel, C.K. (1997). Physician-assisted death in the context of disability . In R. F. Weir (Ed.), Physician assisted suicide (pp. 155—166). Bloomington: Indiana University Press.
33.
Krakauer, E.L., Crenner, C., & Fox, K. (2002). Barriers to optimum end-of-life care for minority patients. Journal of the American Geriatrics Society, 50, 182—190.
34.
Lantos, J.D. (1994). Futility assessments and the doctor-patient relationship . Journal of the American Geriatrics Society, 42, 868—870.
35.
Lo, B. (1991). Unanswered questions about DNR orders. Journal of theAmerican Medical Association, 265, 1874—1875.
36.
Longmore, P.K. (1991). The strange death of David Rivlin. The Western Journal of Medicine, 154, 615—616.
37.
Mayo, D.J., & Gunderson, M. (2002). Vitalism revitalized: Vulnerable populations, prejudice, and physician-assisted death. The Hastings Center Report, 32(4), 14—21.
38.
Miller, P.S. (1993). The impact of assisted suicide on persons with disabilities—Is it a right without freedom? Issues in Law &Medicine, 9, 47—62.
39.
Murphy, D.J. (1988). Do-not-resuscitate orders: Time for reappraisal in long-term-care institutions. Journal of theAmerican Medical Association, 260, 2098—2101.
40.
National Council on Disability. (1997). Assisted suicide: A disability perspective. Washington, DC: Author.
41.
Orentlicher, D. (1992). The illusion of choice in end-of-life decisions. Journal of theAmerican Medical Association, 267, 2101—2104.
42.
Orentlicher, D. (1996). The legalization of physician-assisted suicide . The New England Journal of Medicine, 335, 663—667.
43.
Orentlicher, D. (1997). The Supreme Court and physician-assisted suicide— rejecting assisted suicide but embracing euthanasia. The New England Journal of Medicine, 337, 1236—1239.
44.
Orentlicher, D. (2000). The implementation of Oregon's Death with Dignity Act: Reassuring, but more data are needed. Psychology, Public Policy, and Law,6, 489—502.
45.
Peters, P.G., Jr. (1997). When physicians balk at futile care: Implications of the disability rights laws. Northwestern University Law Review, 91, 798—864.
46.
Prendergast, T.J. (1997). Resolving conflicts surrounding end-of-life care . New Horizons, 5, 62—71.
47.
Quill, T.E., Coombs Lee, B., & Nunn, S. (2000). Palliative treatments of last resort: Choosing the least harmful alternative. Annals of Internal Medicine , 132, 488—493.
48.
Quill, T.E., Lo, B., & Brock, D.W. (1997). Palliative options of last resort: A comparison of voluntarily stopping eating and drinking, terminal sedation, physician-assisted suicide, and voluntary active euthanasia. Journal of theAmerican Medical Association, 278, 2099—2104.
49.
Rosenblatt, L., & Block, S.D. (2001). Depression, decision making, and the cessation of life-sustaining treatment. The Western Journal of Medicine , 175, 320—325.
50.
Schneiderman, L.J., & Jecker, N.S. (1995). Wrong medicine: Doctors, patients, and futile treatment. Baltimore: Johns Hopkins University Press.
51.
Schneiderman, L.J., Jecker, N.S., & Jonsen, A.R. (1990). Medical futility: Its meaning and ethical implications . Annals of Internal Medicine, 112, 949—954.
52.
Scofield, G.R. (1991). Is consent useful when resuscitation isn't?The Hastings Center Report, 21(6), 28—36.
53.
Silvers, A. (1998). Protecting the innocents from physician-assisted suicide: Disability discrimination and the duty to protect otherwise vulnerable groups. In M. P. Battin, R. Rhodes, & A. Silvers (Eds.), Physician-assisted suicide: Expanding the debate (pp. 133—148). New York: Routledge .
54.
Solomon, M.Z. (1993). How physicians talk about futility: Making words mean too many things. The Journal of Law, Medicine & Ethics , 21, 231—237.
55.
SUPPORT Principal Investigators. (1995). A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). Journal of the American Medical Association , 274, 1591—1598.
56.
Troug, R.D., Brett, A.S., & Frader, J. (1992). The problem with futility. The New England Journal of Medicine, 326, 1560—1564.
57.
Veatch, R.M., & Spicer, C.M. (1992). Medically futile care: The role of the physician in setting limits. American Journal of Law &Medicine , 18, 15— 36.
58.
Wardle, L.D. (1987). Sanctioned assisted suicide: “Separate but equal” treatment for the “new illegitimates.” Issues in Law &Medicine, 3, 245—265.
59.
Weijer, C. (1999). Medical futility: Physicians, not patients, call the shots. The Western Journal of Medicine, 170, 254.
60.
Werth, J.L., Jr. (2000). How do the mental health issues differ in the withholding/withdrawing of treatment versus assisted death?Omega, 41, 259—278.
61.
Werth, J.L., Jr., Gordon, J.R., & Johnson, R. (2002). Psychosocial issues near the end of life. Aging & Mental Health, 6, 402—412.
62.
Working Group on Assisted Suicide and End of Life Decisions. (2000). Report to the board of directors. Washington, DC: American Psychological Association . Retrieved December 15, 2003, from http://www.apa.org/pi/aseolf.html
63.
Youngner, S.J. (1988). Who defines futility? Journal of theAmerican Medical Association, 260, 2094—2095.
64.
Youngner, S.J. (1994). Applying futility: Saying no is not enough. Journal of the American Geriatrics Society, 42, 887—889.
