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Extract Medicine depends on more than competence and expertise, essential as these are. It cannot function as an institution without good faith on the part of provider, patient and the public as a whole. The root of the public’s trust is the confidence that physicians will put patients’ welfare ahead of all other considerations, even the patients’ momentary wishes or the physicians’ monetary gain. It is the function of medicine as a profession to safeguard and promote this trust in the society at large. This point could be phrased as a maxim: “Medicine must always be treated as a public good, never as a commodity.” . . . medicine must take the lead in a public conversation about the profession’s contract with society. If it does not, that contract is likely to be redefined in terms, and in a language, quite antithetical to the core concerns of medicine.
Johanna H. Groenewoud, Agnes van der Heide, Bregje D. Onwuteaka-Philipsen, Dick L Willems, Paul J van der Maas, Gerrit van der Wal
New England Journal of Medicine
Abstract Background and Methods The characteristics and frequency of clinical problems with the performance of euthanasia and physician-assisted suicide are uncertain. We analyzed data from two studies of euthanasia and physician-assisted suicide in the Netherlands (one conducted in 1990 and 1991 and the other in 1995 and 1996), with a total of 649 cases. We categorized clinical problems as technical problems, such as difficulty inserting an intravenous line; complications, such as myoclonus or vomiting; or problems with completion, such as a longer-than-expected interval between the administration of medications and death.
Results In 114 cases, the physician’s intention was to provide assistance with suicide, and in 535, the intention was to perform euthanasia. Problems of any type were more frequent in cases of assisted suicide than in cases of euthanasia. Complications occurred in 7 percent of cases of assisted suicide, and problems with completion (a longer-than-expected time to death, failure to induce coma, or induction of coma followed by awakening of the patient) occurred in 16 percent of the cases; complications and problems with completion occurred in 3 percent and 6 percent of cases of euthanasia, respectively. The physician decided to administer a lethal medication in 21 of the cases of assisted suicide (18 percent), which thus became cases of euthanasia. The reasons for this decision included problems with completion (in 12 cases) and the inability of the patient to take all the medications (in 5).
Conclusions There may be clinical problems with the performance of euthanasia and physician-assisted suicide. In the Netherlands, physicians who intend to provide assistance with suicide sometimes end up administering a lethal medication themselves because of the patient’s inability to take the medication or because of problems with the completion of physician-assisted suicide.
Abstract This contribution deals with the issue of the professional autonomy of the medical doctor. Worldwide, the physician’s autonomy is guaranteed and limited, first of all, by Codes of Medical Ethics. In Italy, the latest version of the national Code of Medical Ethics (Code 1998) was published in 1998 by the Federation of provincial Medical Asso- ciations (FNOMCEO). The Code 1998 acknowledges the physician’s autonomy regarding the scheduling, the choice and application of diagnostic and therapeutic means, within the principles of professional responsibility. This responsibility has to make reference to the following fundamental ethical principles: (1) the protection of human life; (2) the protection of the physical and psychological health of the human being; (3) the relief from pain; (4) the respect for the freedom and the dignity of the human person, without discrimination; (5) an up-to-date scientific qualification (Art. 5). The authors underline that autonomy is an anthropological – and consequently ethical – characteristic of the human person. Different positions on autonomy in bioethics (individualistic, evolutionistic, utilitarian and personalistic models) are explained. The relation between the professional autonomy of the physician and the autonomy of the patient and of colleagues is discussed. In fact, the medical doctor is obliged: (1) to respect the fundamental rights of the person, first of all his/her life; (2) to ensure the continuity of the care, even if he can only relieve the patient’s suffering; (3) to maintain, except under certain circumstances, professional secrecy and confidentiality regarding patients and their medical records. Moreover, the physician cannot deny the patient correct and appropriate information. He/she should not perform any diagnostic or therapeutic activity without the informed consent of the patient and the medical doctor must give up medical treatment in case of documented refusal of the individual. Furthermore, the medical doctor has the right to raise conscientious objections if he/she is requested to perform medical actions that are contrary to his/her conscience or medical opinion, unless this attitude would seriously and immediately harm the patient. Regarding the relationships with colleagues, the physician is obliged to solidarity, mutual respect, and care of sick colleagues. Finally, the authors discuss the Italian legislation affecting the physician’s professional autonomy: (1) the SSN health care Acts; (2) the so- called Charter for Public Health Care Services; (3) the Acts on privacy; (4) Good Clinical Practice.
