To those who consider patient autonomy one of the most important concepts in modern healthcare, being able to choose when to die is respected as part of that autonomy. However, euthanasia is a hotly contested issue and is especially debated with respect to mental illness. Euthanasia for untreatable psychiatric illness is currently permitted by law in the Netherlands, Belgium, and Switzerland. However, a recent study by the National Institutes of Health (NIH) has shown that many psychiatric patients euthanized in the Netherlands may have suffered from treatable mental illnesses, such as depression. In fact, of the patients whose case files were studied, more than half had previously refused at least one form of treatment with many of those patients citing “lack of motivation” as the reason for their refusal. Moreover, the study found that many of the psychiatric patients who requested to be euthanized were motivated by “loneliness” or “social isolation,” often symptoms of depression.
Although Dutch law requires that a “disorder be intractable and untreatable” to warrant euthanasia, the study also found that patients are able to seek out euthanasia after being refused, from other physicians, non-psychiatrists, and on-call mobile euthanasia clinics, sometimes on rather questionable grounds. As a result, the study questions whether the Dutch system “provides sufficient regulatory oversight” and casts doubt on diagnostic criteria that allow a symptom of an underlying, possibly treatable condition to determine whether the condition itself is untreatable. While the ethical use of euthanasia for patients suffering from mental illness will undoubtedly continue to be debated, the NIH study certainly makes clear that questions about the treatability of “untreatable” mental conditions must be resolved to protect an already vulnerable population from falling victim to its own self-fulfilling prophecy.
In June, the New York State Court of Appeals ruled against New York City’s ban on selling sugary drinks larger than 16 ounces. The Court held that the city’s Board of Health “exceeded the scope of its regulatory authority” with the regulation. This is the third time that New York courts have decided against the “big-soda ban” and was the final blow to the regulation. Although New York City Mayor Bill de Blasio indicated that his administration would consider other ways to curb the obesity epidemic, no new proposals have been announced.
Soon, Congress will hear testimony concerning the Helping Families in Mental Health Crisis Act. Republican representative, Tim Murphy, from Pennsylvania, sponsored the bill, and, though many agree that the mental health care system requires revamping, some provisions in the bill have sparked controversy. Among the more controversial provisions is one that supports the increased use of involuntary outpatient treatment—via court-ordered therapy for “certain mentally ill people with a history of legal or other problems.” Detractors of this provision claim that it will erode trust in doctor-patient relationships, and that it presents a civil rights issue. However, 45 states have compelled treatment programs already, one of which is New York.
New York’s compelled treatment program, Kendra’s Law, was passed in 1999. Since the implementation of Kendra’s Law, studies show that the percentage of patients returning to the hospital or getting arrested has greatly decreased. The statistic is significant, as “about 350,000 Americans with a diagnosis of severe mental illness…are in state jails and prisons” and the availability of psychiatric beds meets only 10 percent of that need.
Anti-fetal homicide laws were enacted originally to protect mothers of unborn children against violent acts. Yet, in reality, “they’ve led to disproportionate prosecution against African American women who suffer miscarriages.” An ongoing case in Mississippi could set a dangerous precedent with regard to the criminalization of pregnant women for their purportedly reckless acts. Rennie Gibbs was charged with the murder of her unborn child after it was stillborn when she was 16 years old. Gibbs is being prosecuted for “depraved heart murder” because the autopsy showed that Gibbs had used cocaine during her pregnancy—but the cause of death was originally attributed to the umbilical cord being wrapped around the infant’s neck. That cause of death was never ruled out.
A bitter court battle is raging over whether an elderly Brooklyn woman should continue to be kept alive. Sylvia Sodden, 78, is still on life support, even though her original health care proxy agreed to its removal. In 2011, Sodden appointed her godson, Joe Arrigo, as her health care proxy. Arrigo is Catholic, and states that Sodden converted from Orthodox Judaism to Catholicism when she was 20 years old. He states also that Sodden did not want to be on life support, and that “she didn’t want to end up like this.” He consulted with two priests prior to making the decision to remove life support.
However, on March 18, 2014 a Brooklyn Supreme Court Judge determined that Esther Feigenbaum, Sodden’s sister, would replace Arrigo as Sodden’s health care proxy. Feigenbaum claims that Sodden never converted, and that shutting down life support is “anathema to Orthodox Jewish belief.” The Court indicated that part of its decision to divest Arrigo of his role as health care proxy rested on the fact that Arrigo was absent from Court on the day of the proceedings. Arrigo maintains that he did not know he was supposed to appear.
JAMA Internal Medicine published a research letter by authors J. Eric Oliver, PhD and Thomas Wood, MA, which indicates that almost half of the nation believes in at least one health conspiracy. For example, thirty-seven percent of Americans believe that the Food and Drug Administration is concealing natural cures for cancer in response to industry pressure from pharmaceutical companies. The authors conducted an online survey of 1,351 adults; the survey posited four health conspiracy theories. Forty-nine percent of those polled indicated that they believe at least one of the proposed theories, and eighteen percent believe in at least three. According to Oliver, the takeaway from the survey “is that people who embrace these conspiracies are very suspicious of traditional evidence-based medicine.
Dr. Sandeep Jauhar, a cardiologist, offers anecdotal evidence in support of his argument that even though autonomy is, and should be, medicine’s guiding principle, paternalism has its place. The principle of autonomy in medicine encompasses a patient’s right to direct care his or her care, and requires the doctor to fully inform the patient regarding medical treatment. Dr. Jauhar reflects on his early belief that autonomy was “an absolute good, an ethical imperative that trumped all others.” After some years practicing medicine, his belief has changed.
Dr. Jauhar has come to believe that “no ethic in medicine is absolute.” Though the consequences of a breach of trust between a physician and a patient are severe, the consequences of full disclosure can be adversarial to the doctor’s duty to select the best course of treatment for his or her patients. However, Dr. Jauhar states that if a doctor believes that a paternalistic approach is necessary to a patient’s care, a soft approach is most appropriate. He describes hard paternalism as “coercive,” while soft paternalism “involves negotiation.”
New York State Assembly Member, Linda Rosenthal, is the sponsor of a bill that would require genetically modified food, otherwise known as “GMO’s,” to be labeled as such. Even though the bill has bipartisan support now, this is the second time it has been proposed; the bill was voted down in June of 2013. States such as Connecticut and Maine have enacted GMO labeling laws. However, neither of the states’ laws on GMO labeling will go into effect until other states in the Northeast region of the U.S. enact similar legislation. Recently, a relatively similar bill was voted down in New Hampshire, but in New Hampshire the effect of the law would not have been contingent upon the actions of surrounding states.
Montreal’s Health and Social Service Agency requires doctors to “inform off-island patients about treatments available closer to their homes.” Montreal patients, off-island or otherwise, have the right to be treated wherever they wish. However, the agency claims that, by suggesting that off-island patients be treated closer to their homes, the policy conserves the resources of Montreal’s hospitals. Some claim that the policy may confuse patients, and may even discriminate against patients who travel in order to receive specialized care.
A nurse named Barbara Mancini was accused of homicide in 2013. Allegedly, she handed her father a bottle of morphine with the intent to assist in his suicide. Her father, Joseph Yourshaw, 93 years old, suffered from end stage renal disease and was in home hospice. However, the case has been dismissed. Judge Jacqueline Russell stated in her decision that the Pennsylvania Attorney General did not prove that Ms. Mancini gave Mr. Yourshaw the morphine with the intent to assist in his suicide, and that Ms. Mancini could have intended solely to alleviate his suffering. Some believe that though assisted suicide is legal in five states only, this decision “is the latest in a series of recent developments signaling the reluctance of courts” and legislatures to criminalize medical treatment that “may hasten death.”