The Supreme Court addresses physician-assisted suicide. Can its rulings improve palliative care?
In June 1997, the US Supreme Court unanimously decided that competent, terminally ill patients have no general constitutional right to commit suicide or to obtain assistance in committing suicide. Thus, the broad prohibitions against any kind of suicide assistance that almost every state has enacted do not violate the constitution. While many of the rulings and the bulk of the reaction to them focused on the Supreme Court's resolution of important legal controversies regarding physician-assisted suicide, this article focuses on the resulting potential for change in physicians' opinions on palliative care. The Court's reasoning may help physicians resolve substantial ethical dilemmas regarding the provision of narcotics given in high dosages, the care of incompetent patients, and the suffering caused by symptoms other than pain. For example, the Court concluded that a physician's intent can distinguish permissible acts of aggressive pain relief from impermissible acts of hastening death. This distinction has clinical uses and can help physicians develop ethical guidelines and practice standards to improve palliative care near the end of life.
Alpers
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Program in Medical Ethics, University of California, San Francisco, USA. anna@medicine.ucsf.edu
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D003128:Coma / Q000139:chemically induced; D034723:Double Effect Principle; D004989:Ethics; D004992:Ethics, Medical; D028601:Euthanasia, Active; D033161:Government Regulation; D006801:Humans; D033182:Intention; D028681:Moral Obligations; D009294:Narcotics / Q000009:adverse effects; D010146:Pain / Q000188:drug therapy; D010166:Palliative Care / Q000592:standards*; D013315:Stress, Psychological; D017236:Suicide, Assisted / Q000331:legislation & jurisprudence*; D035521:Supreme Court Decisions; D013727:Terminal Care / Q000592:standards*; D014481:United States; D035761:Wedge Argument; D028761:Withholding Treatment
D009294:Narcotics