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.
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.”
Medical research, conducted recently on approximately 2,000 premature children born with anemia, has sparked an ethical debate over how much doctors must tell patients and their parents regarding the risks of medical research. The study aimed to uncover the most appropriate time to administer a blood transfusion to premature babies in order to reduce their risks of death and brain damage. Extremely premature babies received different dosages of oxygen in order to find the dosage that most effectively lowers the risk of blindness and death for premature children generally. The ethical debate concerns whether the parental consent form adequately informed the parents about the parameters of the study.
Neuroblastoma is a cancer of the nervous system that occurs in children, and is almost always fatal. Fifteen percent of cancer deaths in children result from neuroblastoma. Often, in the most severe cases of neuroblastoma, the gene CHD5 is inactive. A study conducted by Johan Holmberg, PhD, at the Ludwig Institute for Cancer Research Stockholm, examined CHD5’s role as a tumor suppressor in order to learn how it operates in healthy tissue. The researchers thwarted the activity of CHD5 in the brains of fetal mice; their findings indicate that, in order for a cell to transition from a stem cell into a mature neuron, CHD5 must be active. The findings could lead to new and more effective ways to treat neuroblastoma, as well as gliobastoma multiforme, which is the most common and lethal form of brain cancer in adults.
Doctor’s groups, such as the American Medical Association, have urged the U.S. military to end the practice of force-feeding detainees in Guantanamo who have engaged in a hunger strike. Force-feeding requires that doctors and nurses strap the detainee to a chair, gag the detainee’s mouth, and then insert a nasogastric tube. The insertion of a nasogastric tube is uncomfortable in the extreme, even for a willing patient. Detainees resisting tube insertion may gag, have trouble breathing, or vomit. A motion filed in federal court to end the practice was rejected by U.S. District Judge Rosemary M. Collyer. Judge Collyer stated that the Court did not have jurisdiction, and if it did she would still reject the complaint. She claims that the “real complaint” is that the U.S. Government refuses to allow the detainees to starve themselves to death.
“Do Not Resuscitate” (DNR) orders only apply to situations of cardiac arrest. According to the NYS Department of Health, DNR orders have no application to any other medical situation or treatment. That is not always clear, however. As a result, DNR orders are sometimes relied on by medical professionals’ to suggest patients’ wishes in situations other than cardiac arrest. Moreover, a patient could have a DNR order because she suffers from a chronic illness, yet if she were in a car accident, and the resulting injuries required life-sustaining treatment, she may not want the DNR to apply.
In answer to the problems created by DNRs, almost all of the states in the U.S. have adopted or are in the process of adopting “physician order[s] for life-sustaining treatment” (POLSTs). (NY uses a comparable form called a MOLST (Medical Orders for Life-Sustaining Treatment.) POLSTs are more explicit than DNRs, and they specify “a patient’s goals and desires as death closes in.” A POLST must be signed by a doctor or other medical professional, and in most states the patient or a designated surrogate must sign also. Yet, in states such as New York and Oregon, the patient does not have to sign. Some disability advocates argue that patients’ signatures should be required in order to signal full consent. Read more here.
Irom Sharmila was recently charged with attempted suicide in India, arising “from a 2006 protest she attended in New Delhi.” Ms. Sharmila has been on a hunger strike for the last 12 years, in protest of an Indian law that allows troops to shoot and kill suspected rebels and authorizes warrantless arrests of suspected militants in conflict areas. Ms. Sharmila has not voluntarily eaten since November of 2000, however she has been subjected to mandatory nasogastric feeding since three days after beginning her hunger strike. If convicted of attempted suicide, she could serve up to one year in prison. Read more here.
Civil Beat recently published a Community Voices article by Dr. Charles Miller called “Aid-in-Dying is Not Assisted Suicide.” In his article, Dr. Miller, founder of the Physician Advisory Council for Aid in Dying (PACAID), promotes what he euphemistically calls “aid-in-dying” in lieu of the generally accepted term “assisted suicide.”
Groups like PACAID attempt to obfuscate the moral and legal issues surrounding assisted suicide in Hawaii by using the euphemism “aid-in-dying.” However, the real meaning of this term becomes clear by an understanding of the group’s mission, which is to promote physician involvement in hastening patients’ deaths, such as through issuing a prescription for lethal drugs.