The Journal of clinical ethics
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This issue's "Legal Briefing" column covers legal developments pertaining to conscience clauses and conscientious refusal. Not only has this topic been the subject of recent articles in this journal, but it has also been the subject of numerous public and professional discussions. Over the past several months, conscientious refusal disputes have had an unusually high profile not only in courthouses, but also in legislative and regulatory halls across the United States. ⋯ Fertility, HIV, vaccines, counseling 7. End-of-life measures: right to refuse 8. Comprehensive laws: right to refuse.
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Historical Article
The 10-year experience of Oregon's Death with Dignity Act: 1998-2007.
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To adapt Churchill's comment on democracy, "No one pretends that [POLSTs are] perfect..." but physicians' orders about life-sustaining treatments are a very important supplement to advance directives, especially for patients who are extremely or terminally ill, and most particularly for patients who require emergency treatment by first responders or by physicians who do not know them as persons. The standardized orders of limited options, however, are no substitute for a detailed treatment directive of a patient with a known illness, with predictable trajectories and complications. And, in this latter circumstance, a thoroughly informed proxy may also assist physicians in selecting appropriate treatment for patients who have lost decisional capacity and/or the ability to express it. ⋯ In learning to talk to his patients, the doctor may talk himself back into loving his work. He has little to lose and everything to gain by letting the sick man into his heart. If he does, they can share--as few others can--the wonder, terror, and exultation of being on the edge of being"
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On balance, the potential harms and benefits of circumcision in an older child or adolescent are sufficiently closely aligned that parents should be permitted to make decisions about circumcision on behalf of their children. To make a case for prohibition, medical harms would have to be of such likelihood and magnitude that no reasonable potential benefit (social, religious, cultural, or medical) could justify doing it to a child. However, I would suggest that the following additional principles should apply: (1) Informed permission from parents is essential. ⋯ Jimmy is her son, and she has an interest in seeing his welfare protected. Whether or not she has legal rights, I would be very reluctant to perform an elective procedure for cultural or religious reasons without the permission of both parents and the unambiguous assent of Jimmy himself. Neither appears to be present in the case as it presented to the courts.