Journal of medical ethics
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The mental competence of people requesting aid-in-dying is a key issue for the how the law responds to cases of assisted suicide. A number of cases from around the common law world have highlighted the importance of competence in determining whether assistants should be prosecuted, and what they will be prosecuted for. ⋯ The test will help doctors, other health professionals and lawyers determine whether the suicidal person was able to competently request assistance. Such knowledge will help to reduce some of the current uncertainty about criminal liability in cases of assisted suicide.
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Journal of medical ethics · Jan 2011
Ethical and legal acceptability of the use of neuromuscular blockers (NMBs) in connection with abstention decisions in Dutch NICUs: interviews with neonatologists.
In the Netherlands, using drugs to deliberately end the life of a severely defective newborn baby who is in extreme suffering can be permissible under very precise circumstances. This does not mean that all Dutch neonatologists are willing to engage in such behaviour. This paper discusses the use of neuromuscular blockers (NMBs) in connection with abstention decisions in neonatology and the boundaries between 'deliberate ending of life' and other end-of-life decisions. These boundaries are of paramount importance because, of all end-of-life decisions, only 'deliberate ending of life' must be reported by the responsible doctor and exposes him to the risk of being prosecuted. ⋯ Doctors' responses were heterogeneous, showing that the acceptability of using NMBs in certain situations and the boundaries between end-of-life decisions are currently a subject of discussion among Dutch neonatologists. Many respondents reported feeling threatened by the potential involvement of the criminal law authorities in the system of control over 'deliberate ending of life'.
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Journal of medical ethics · Jan 2011
Is best interests a relevant decision making standard for enrolling non-capacitated subjects into clinical research?
The 'best interests' decision making standard is used in clinical care to make necessary health decisions for non-capacitated individuals for whom neither explicit nor inferred wishes are known. It has been also widely acknowledged as a basis for enrolling some non-capacitated adults into clinical research such as emergency, critical care, and dementia research. However, the best interests standard requires that choices provide the highest net benefit of available options, and clinical research rarely meets this criterion. In the context of modern norms of bioethics, the best interests standard rarely supports surrogate consent for research and should not be accepted as a routine provision.