Issues in Law & Medicine

Journal covering legal and ethical issues in the delivery of medical care.

Articles from Vol. 28, No. 2, Fall

Appendix 1: Nazi Euthanasia
The modern movement in favor of euthanasia has been often accused of trying to repeat the practices of the Nazis, and with equal insistence its representatives have repudiated these allegations. Due to inaccuracies in arguing, and thinking, the dispute...
Appendix 2: Voices from Mensa
Mensa is an association of the best and the brightest, persons with an "IQ" so high that it places them in the top two percent of the population. In 1994, American Mensa Ltd. had 55,000 members, 2,000 of them in the Los Angeles area. At the end of...
Chapter I. Bioethics versus Medicine
Lay Adventures in the World of Medicine. What the public thinks of doctors and medicine is often true, sometimes wrong, and at times touchingly amusing. A lady once told me: "Oh, doctor, you are so marvelously calm, even when I get sick, or when I...
Chapter III: The Attack on Medicine
The doctor, looking grave and solemn, began his examination. He took the patient's pulse rate and body temperature, and proceeded to the percussion and auscultation. With a certainty that left no room for doubt, Ivan Ilyich knew that all this was rubbish...
Chapter II: On the Ethics of Physicians
Attempts to incorporate medical ethics in a universally valid ethical system are certainly justified, but have not been entirely successful. When considering contemporary ethical systems, many physicians do not find the reflection of their own ethical...
Chapter IV: The Responsibility and the Morale of Physicians
Doing More Than Required. One of 20th century's most talented Polish poets was admitted to the Omega Clinic, Warsaw's fashionable medical center, with vague abdominal complaints. Nothing particular was found upon routine examination. Gastroscopy and...
Chapter IX: On Therapy
Dr Loeb's Five Rules of Therapeutics. Dr. Robert F. Loeb was said to be "in semi-humorous vein" when he proposed his Rules: 1. The Golden Rule: Don't do to the patient what you wouldn't like to be done to yourself. 2. If what you are doing is...
Chapter VIII: More on the Medical Mind
In Praise of Anecdotal Evidence. In this book I report a number of case histories, and I am often using these to make a point. Some scientific-minded readers may tend to dismiss these stories as merely anecdotal evidence. Please don't do that. Properly...
Chapter VII: The Medical Mind
Learning Medicine From a Master. In 1997, Dr. Joseph Stanton invited me to address the students and recent graduates of Harvard Medical School who were taking the restated Hippocratic Oath. Here is what I said: (80) Dear Friends, I want to draw...
Chapter VI: Speaking the Truth
"Falsehood is in itself bad and reprehensible," states Aristotle in The Nicomachean Ethics, "while the truth is a fine and praiseworthy thing." (55) He does not say why. There seem to be important reasons to respect and value the truth. We need some...
Chapter V: The Motivation of Physicians
During the twenty years of the attack on medicine that I witnessed in Holland, the media, politicians, and "people in the street" expressed the opinion that doctors' sole reason to do their work was the big money they were making. The anti-medical...
Chapter XIII: Farewell to Clinical Medicine?
My Left Kidney. I recently complained of pain in my left side; it appeared during a urinary infection, and recurred four months later. I examined myself as well as I could, and told my HMO internist that I had palpated the lower pole of my left kidney,...
Chapter XII: The Lost Skills, the Bad Habits
The Remarkable Congressional Hearings. The hearings were held in January, 2000, and Ms. D, the fastest woman on earth, the 100 meter-sprint Olympic golden medallist, took the stand. She told a stunning story. "A string of doctors failed to diagnose...
Chapter XIV: Nurses Misled
The Nurses Take Over the Physical. You should not think that clinical medicine has been totally abandoned. At the Boston area hospital where I spent a whole month watching a single patient, almost every day a physical examination was performed by the...
Chapter XI: What Is Happening to Physicians' Manners and Morals?
A Gothic Tale From The X-Ray Conference Room. When I left Poland in 1968, I first settled in Nakskov, on Denmark's southernmost island. I was appointed deputy head of Nakskov Hospital's department of internal medicine. This was a large department of...
Chapter XIX: Crypthanasia
I use the term crypthanasia (from Greek kryptos, secret, hidden, and Thanatos, The Death) to denote covert medical killings of unsuspecting patients. (164) Excerpts From Dutch Publications on Crypthanasia. The reality of crypthanasia is illustrated...
Chapter X: The Traditional Clinician
When I turn my mind to the environment in which I was educated as a physician, to my teachers and my colleagues, a certain radiance surrounds this circle of people. What kind of people were they? What kind of person did I try to become? The general...
Chapter XVII: Do We Treat All Patients, or May We Refuse to Help Some of Them?
Mount Taigetos. In Sparta all newborn children had to be presented to the Ephors of State, who selected the ones they considered robust and healthy. All other children were left on the slopes of Mount Taigetos as prey for wild dogs and predatory birds....
Chapter XVIII: Biological Cleansing at the Beginning of Life
In 1988, a baby born with Down syndrome vomited all nourishment and was admitted to one of Holland's leading centers for pediatric surgery, the Sophia Hospital in Rotterdam. It was found that the child had an inborn defect of the digestive tract, duodenal...
Chapter XVI: In Defense of Medicine
The Crisis. One of the principal causes of the current crisis in medicine is the profession's failure to control the invasion of basic sciences and technology, the inability to subordinate their contribution to medicine's human aims. Obviously, we...
Chapter XV: Is Medicine Still for the Patient?
The Patient Is Our Priority. In 1991, I said the following in answer to a question from an interviewer: "In a hospital, the sick person may be taken aback when confronted with all those machines and with an organization which seems so impersonal; but...
Chapter XX: Dutch Government-Ordered Surveys of Euthanasia
In 1990, the government-appointed committee on euthanasia, chaired by professor J. Remmelink, commissioned the Institute for Social Health Care of the Erasmus University in Rotterdam to conduct a nationwide survey. While the project was discussed in...
Chapter XXIII: Doctors Who Practice Euthanasia
Even in the early days some observers warned that euthanasia was not just another procedure added to the medical practice but would change the physician's whole attitude and also their professional performance. The predictions proved right. Handling...
Chapter XXII: Utilitarianism of Bentham-Mill-Singer and the Philosophy of Euthanasia
Jeremy Bentham was born in 1748 and died 84 years later, but it was said that nothing ever happened to him; that he never experienced any human misfortunes or elations; that he was arid, devoid of imagination; that instead of living people he saw schematic...
Chapter XXI: The Philosophy of Euthanasia
Use logic to overcome the scruple. (245) Francois Mauriac The advocates of physician-assisted suicide, or voluntary euthanasia, present the following argument: * Hopelessly ill people who in the end will have to die in unbearable pain, wish...
Chapter XXIV: At the Bottom
The Reticent Family Physician. The story of a six year old boy, his parents, and their family physician has been published in a leading Dutch medical journal. (355) The boy had some behavioral problems, and his intelligence seemed below average. He...
Chapter XXIX: The Shaping of Public Opinion
In Holland, the opinion polls conducted in the last three decades have shown an increasing acceptance of euthanasia by the public: in 1986, 76 to 77 percent of the respondents supported euthanasia (whether voluntary or involuntary), (538) in 2001 the...
Chapter XXVII: Death in the Gray Zone
The Death of Gene McC. (461) Shalom Newman was on the phone. Shalom: I can hardly believe what Halina told me about Gene's last days. Do you think it can be true? Richard: I see no good reason to doubt the story. Unfortunately, nowadays those...
Chapter XXVIII: American Assisted Suicide
A Family Conversation in Sarasota (491) I have always liked best the West Coast of Florida, with its wonderful abundance of birds, egrets, sandpiper and plunging brown pelicans. Gina's first cousin Irving and his wife Mary used to spend the winters...
Chapter XXVI: Staying to the Very End at the Patient's Side
Letting Die. Obviously, this concept spans a wide range of decisions. Many such decisions are medically and morally sound. At the other end of the spectrum are criminal decisions such as deliberately causing death of a diabetic child by denying him...
Chapter XXV: The Hippocratic Physician and the Changing World
The date was January 8, 1997, I was on the witness stand at the Palm Beach Court, (401) and Judge Joseph Davis asked me: "Doctor, can you imagine some special circumstances in which you would help a patient to end his life?" "No, Your Honor." "How...
Chapter XXXII: Toward a Killing Society
An Abstract Discussion of a Concrete Issue. The extensive debate on euthanasia and assisted suicide has been surprisingly abstract. The actual deaths from euthanasia, the reality of death and of putting people to death, have almost never been mentioned....
Chapter XXXI: Who Is Leading Us There?
The right-to-die movement, a great popular movement sweeping half the globe couldn't develop without organization, paid workers, newsletters, access to the media, PR specialists, traveling speakers, campaign headquarters active before every referendum,...
Chapter XXX: The Society That Has Embraced Euthanasia
In the last three decades euthanasia has become one of the main issues, and the most discussed issue in Dutch public life, politics, and national conscience. Euthanasia is supported by all major Dutch political parties and by a majority of Dutch Catholics,...
(Introduction to the Book and Part One: In Defense of Medicine)
This book is about the transformation of traditional medicine into the modern "scientific" variety, and the patients' and doctors' adventures on this journey. It is also about losses. The ethical and intellectual costs of modernization are proving...