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Correspondence |

Deconstructing the Code of Medical Ethics and Practice in End-of-Life Care Disputes: Infringing on Well-Grounded Cultural Values in Pluralistic Societies FREE TO VIEW

Mohamed Y. Rady, BChir, MB (Cantab), MA, MD (Cantab); Joseph L. Verheijde, PhD, MBA, PT; Greg Yanke, JD, MBA, MSBA
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

aDepartment of Critical Care Medicine, Mayo Clinic Hospital, Phoenix, AZ

bDepartment of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, AZ

cSchool of Historical, Philosophical, & Religious Studies, Arizona State University, Tempe, AZ

CORRESPONDENCE TO: Mohamed Y. Rady, BChir, MB (Cantab), MA, MD (Cantab), Department of Critical Care Medicine, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ, 85054


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(6):1425-1426. doi:10.1016/j.chest.2016.09.040
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In the article by Bosslet et al published in CHEST (September 2016), the authors contrasted processes for extramural resolution of intractable conflicts about medical futility or inappropriate treatment at the end of life in the United States, Canada, and the United Kingdom. They concluded that there is insufficient public reason-giving regarding conflicts about end-of-life care in the United States. The authors, however, focused on US reason-giving that is supportive of forgoing life-sustaining treatment (eg, in re Quinlan). The US Supreme Court’s landmark decisions in Vacco v Quill and Washington v Glucksberg were not mentioned. These cases provide informative reason-giving for American society and the medical profession regarding why medically terminating a human life is not a constitutional right. We comment on an emerging trend in medical ethics and practice that can be inferred from Bosslet et al’s analysis.

First, modern medical practice has interpreted the ethical notion of autonomy as a narrowly defined concept. Although some jurisdictions have granted patients the autonomous choice of physician-assisted suicide or euthanasia, they are presumably not to be awarded the same access to continuation of life-sustaining treatment at the end of life. Second, the ethical interpretation of patients’ best interests at the end of life has been reduced predominantly to an external agent’s assessment of quality of life. Extramural bodies invariably endorse such a best interest standard, generally benchmarked unilaterally by professional societies and organizations. As a case in point, death determination by neurologic criteria is based on such a normative assessment of poor quality of life rather than on verifiable neuroscientific criteria. The medical conception of death by neurologic criteria is still being challenged in the McMath case. Nevertheless, Bosslet et al have posited that cases such as McMath “rarely leave a lasting imprint on practice.” We caution against agreeing with the authors’ opinion because the outcome of pending litigation to rescind death certification by neurologic criteria remains unknown. In the United Kingdom, no legal code that defines death by neurologic criteria even exists. However, the code of practice of the Academy of Medical Royal Colleges is routinely used to declare individuals clinically dead, implicitly violating well-grounded religious and cultural values.

Unchallenged medical authority in ethical reinterpretation of autonomy, best interests, and definition of death can have serious negative societal consequences. Advancing societal debate might be better served by legislative initiatives rather than reliance on judicial reason-giving opinions. Discord between medical ethics, clinical practice, and inherent well-grounded societal moral and cultural values at the end of life are likely to increase the frequency of intractable conflicts in pluralistic societies.

References

Bosslet G.T. .Baker M. .Pope T.M. . Reason-giving and medical futility: contrasting legal and social discourse in the United States with the United Kingdom and Ontario, Canada. Chest. 2016;150:714-721 [PubMed]journal. [CrossRef] [PubMed]
 
In re Quinlan, 70 N.J. 10, 355 A.2d 647 (1976).
 
US Supreme Court. Vacco v Quill, 521 U.S. 793 (1997)http://supreme.justia.com/us/521/793andhttp://www.oyez.org/cases/1990-1999/1996/1996_95_1858. Accessed September 17, 2016.
 
US Supreme Court. Washington v. Glucksberg, 521 U.S. 702 (1997).http://supreme.justia.com/us/521/702/andhttp://www.oyez.org/cases/1990-1999/1996/1996_96_110. Accessed September 17, 2016.
 
Yanke G. .Rady M.Y. .Verheijde J.L. . When brain death belies belief. J Relig Health. 2016;55:2199-2213 [PubMed]journal. [PubMed]
 
Jahi McMath v. State of California. Case No. 15-cv-06042-HSG, California Northern District Ct: Oakland Division (2015).
 
Choong KA, Rady MY. Re A (A Child) and the United Kingdom code of practice for the diagnosis and confirmation of death: should a secular construct of death override religious values in a pluralistic society [published online ahead of print August 4, 2016]?HEC Forum.http://dx.doi.org/10.1007/s10730-016-9307-y.
 

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References

Bosslet G.T. .Baker M. .Pope T.M. . Reason-giving and medical futility: contrasting legal and social discourse in the United States with the United Kingdom and Ontario, Canada. Chest. 2016;150:714-721 [PubMed]journal. [CrossRef] [PubMed]
 
In re Quinlan, 70 N.J. 10, 355 A.2d 647 (1976).
 
US Supreme Court. Vacco v Quill, 521 U.S. 793 (1997)http://supreme.justia.com/us/521/793andhttp://www.oyez.org/cases/1990-1999/1996/1996_95_1858. Accessed September 17, 2016.
 
US Supreme Court. Washington v. Glucksberg, 521 U.S. 702 (1997).http://supreme.justia.com/us/521/702/andhttp://www.oyez.org/cases/1990-1999/1996/1996_96_110. Accessed September 17, 2016.
 
Yanke G. .Rady M.Y. .Verheijde J.L. . When brain death belies belief. J Relig Health. 2016;55:2199-2213 [PubMed]journal. [PubMed]
 
Jahi McMath v. State of California. Case No. 15-cv-06042-HSG, California Northern District Ct: Oakland Division (2015).
 
Choong KA, Rady MY. Re A (A Child) and the United Kingdom code of practice for the diagnosis and confirmation of death: should a secular construct of death override religious values in a pluralistic society [published online ahead of print August 4, 2016]?HEC Forum.http://dx.doi.org/10.1007/s10730-016-9307-y.
 
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