What the clinician taught the ethicist: clinical contributions to ethical concerns.
BACKGROUND
Clinical ethics is often assumed to be a one-way relationship in which ethicists consider the appropriate guidelines for clinical practice and research. This unfortunately ignores the important ways clinical practice informs bioethical thinking.


METHODS
This paper considers the relation between clinical and ethical practice through a consideration of whether there are conditions in which Physician Assisted Suicide, or other forms of euthanasia, serve as an ethically accepted response to chronic illness. At one scale it reviews publicly available data on deaths attributed to euthanasia practitioner Jack Kevorkian to consider the medical rationale of those deaths. At another scale, the 'mercy killing' by Canadian farmer Robert Latimer of his daughter is employed as a case study of surrogate decision making.


RESULTS
A clinical review of the more than seventy cases attributed to Jack Kevorkian from 1990-98 reveals a client base that did not fit publicly or clinically accepted parameters within which euthanasia is generally understood. Few if any of the patients were near the end stage of a chronic progressive disease. Most were able to travel independently. Palliative care was in some cases problematic. The case of Latimer emphasizes the importance of social as well as medical care in cases of chronic illness, and the importance of palliative care as an alternative to


CONCLUSIONS
Clinical ethics is of necessity a two-way street, one in which ethical paradigms influence practitioners and researchers whose expertise, in turn, necessarily educates the non-clinical ethicist.
Koch
Tom
T
Department of Geography, University of Brritish Columbia, Vancouver, BC, Canada. tokoch@attglobal.net
D026688:Bioethical Issues; D003657:Decision Making; D026822:Ethicists; D026690:Ethics, Clinical; D004992:Ethics, Medical; D005065:Euthanasia; D006801:Humans; D033183:Interdisciplinary Communication; D010166:Palliative Care / Q000941:ethics; D010819:Physician's Role; D011788:Quality of Life; D012945:Social Values; D017236:Suicide, Assisted