Withdrawing treatment from patients with prolonged disorders of consciousness: the wrong answer is what the wrong question begets

2020 ◽  
Vol 46 (8) ◽  
pp. 561-562
Author(s):  
Daniel Wei Liang Wang
Keyword(s):  
Disorders Of Consciousness ◽  
Decision Makers ◽  
Best Interests ◽  
Wrong Answer ◽  
Legal Perspective ◽  
Life Sustaining Treatment ◽  
Pros And Cons ◽  
Present Response ◽  
The Right ◽  
Contrary Evidence

In a recent paper, Charles Foster argued that the epistemic uncertainties surrounding prolonged disorders of consciousness (PDOC) make it impossible to prove that the withdrawal of life-sustaining treatment can be in a patient’s best interests and, therefore, the presumption in favour of the maintenance of life cannot be rebutted. In the present response, I argue that, from a legal perspective, Foster has reached the wrong conclusion because he is asking the wrong question. According to the reasoning in two leading cases—Bland and James—the principle of respect for autonomy creates a persuasive presumption against treatment without consent. Therefore, it is the continuation of treatment that requires justification, rather than its withdrawal. This presumption also works as the tiebreaker determining that treatment should stop if there is no persuasive evidence that its continuation is in the best interests of the patient. The presumption in favour of the maintenance of life, on the other hand, should be understood as an evidential presumption on a factual issue that is assumed to be true if unchallenged. However, the uncertainties regarding PDOC actually give reasons for displacing this evidential presumption. Consequently, decision-makers will have to weigh up the pros and cons of treatment having the presumption against treatment without consent as the tiebreaker if the evidence is inconclusive. In conclusion, when the right question is asked, Foster’s argument can be turned on its head and uncertainties surrounding PDOC weigh in to justify the interruption of treatment in the absence of compelling contrary evidence.

Withdrawing treatment from patients with prolonged disorders of consciousness: the presumption in favour of the maintenance of life is legally robust

2020 ◽  
pp. medethics-2020-106280
Author(s):  
Charles Foster
Keyword(s):  
Human Rights ◽  
Disorders Of Consciousness ◽  
Best Interests ◽  
European Convention ◽  
Right To Life ◽  
Withdrawing Treatment ◽  
Life Sustaining Treatment ◽  
English Law ◽  
The Right ◽  
The Way

The question a judge has to ask in deciding whether or not life-sustaining treatment should be withdrawn is whether the continued treatment is lawful. It will be lawful if it is in the patient’s best interests. Identifying this question gives no guidance about how to approach the assessment of best interests. It merely identifies the judge’s job. The presumption in favour of the maintenance of life is part of the job that follows the identification of the question.The presumption is best regarded as a presumption of law. It has long been recognised as part of the way in which the English law discharges its obligations under Article 2 of the European Convention on Human Rights (the right to life). But even if it is a ‘mere’ evidential presumption it cannot, on the facts of most cases involving applications for the withdrawal of life-sustaining treatment from patients in prolonged disorders of consciousness, be rebutted.

Beyond Willpower: Strategies for Reducing Failures of Self-Control

2018 ◽  
Vol 19 (3) ◽  
pp. 102-129 ◽  
Author(s):  
Angela L. Duckworth ◽  
Katherine L. Milkman ◽  
David Laibson
Keyword(s):  
Cognitive Intervention ◽  
Decision Makers ◽  
Self Control ◽  
Best Interests ◽  
Psychological Science ◽  
Contemporary Research ◽  
The Right ◽  
Do The Right Thing

Almost everyone struggles to act in their individual and collective best interests, particularly when doing so requires forgoing a more immediately enjoyable alternative. Other than exhorting decision makers to “do the right thing,” what can policymakers do to reduce overeating, undersaving, procrastination, and other self-defeating behaviors that feel good now but generate larger delayed costs? In this review, we synthesize contemporary research on approaches to reducing failures of self-control. We distinguish between self-deployed and other-deployed strategies and, in addition, between situational and cognitive intervention targets. Collectively, the evidence from both psychological science and economics recommends psychologically informed policies for reducing failures of self-control.

End of Life

2018 ◽  
pp. 73-86
Author(s):  
Zoë Fritz
Keyword(s):  
Assisted Suicide ◽  
General Medical Council ◽  
Mental Capacity ◽  
Best Interests ◽  
Organ Support ◽  
Medical Council ◽  
Life Sustaining Treatment ◽  
Mental Capacity Act ◽  
The Right

All practising clinicians will inevitably have to deal with the death of their patients. It is very important that we acknowledge our own biases and subjugate those to the needs of the patient for whom we are caring. Doctors prescribe drugs to alleviate symptoms or apply organ support to those whose bodies are failing. They can be asked, by patients or families, to provide life-sustaining treatments that do not offer any clinical relief or to administer drugs to ‘end suffering’. At both extremes, there are laws to protect both patient and doctor. It is this legislation, case law, and General Medical Council guidance that will be reviewed in this chapter. Discussion will focus on the right to refuse life-sustaining treatment; the role of the Mental Capacity Act and respecting ‘best interests’; the legal (and philosophical) distinction between withholding and withdrawing treatment; the doctrine of double effect; assisted suicide; and euthanasia.

Disorders of Consciousness and the Disability Critique

2021 ◽  
pp. 214-250
Author(s):  
L. Syd M Johnson
Keyword(s):  
Vegetative State ◽  
Disabled Persons ◽  
Careful Consideration ◽  
Disorders Of Consciousness ◽  
Withdrawal Of Treatment ◽  
Explicit Bias ◽  
History Of ◽  
Life Sustaining Treatment ◽  
The Right ◽  
Implicit And Explicit

Some members of disability communities and activist organizations have strenuously objected to the withdrawal of life-sustaining treatment from persons in the vegetative state/unresponsive wakefulness syndrome, notably in the case of Terri Schiavo. A history of medical neglect and ableism prompts reasonable fears that the rights of disabled persons are threatened by the withdrawal of treatment from patients who lack the ability to decide for themselves. This chapter considers the disability critique of the right to die. Implicit and explicit bias against disabled persons, and the withdrawal of treatment as a means to prevent disability are examined, alongside concerns about epistemic injustice and questions about who has the epistemic authority to speak for those with disorders of consciousness. What we owe to profoundly impaired persons, including those with disorders of consciousness, is what we owe to others: care, careful consideration of their preferences and interests, and respect for their personhood.

scholarly journals (De)Legitimasi Hukuman Pidana Mati: Sebuah Pertimbangan Etis

2019 ◽  
Vol 3 (1) ◽  
pp. 41
Author(s):  
Sonny Eli Zaluchu ◽  
Eirene Kardiani Gulo
Keyword(s):  
Literature Review ◽  
Death Penalty ◽  
Human Life ◽  
Descriptive Analysis ◽  
Ethical Considerations ◽  
Legal Perspective ◽  
The World ◽  
Pros And Cons ◽  
The Right

The death penalty is always in controversy. Ethical considerations in terms of ethics, principle, and criminality always produce two strong opinions, which are the pros and cons. The two opposing views have strong arguments and considerations concerning the maximum punishment for particular crimes. Countries in the world divided into two acts. Some chose the moratorium option, but there were also those who continued to defend it. This article describes that there are indeed substantive difficulties in an attempt to legitimize or delegitimize the death penalty. These difficulties are presented and analyzed in this paper by using theological approaches, especially in a legal perspective, the right to human life and biblical orders not to kill. The descriptive analysis was carried out by utilizing a literature review and research results.AbstrakHukuman mati selalu di dalam kontroversi. Pertimbangan moral dalam hal etika, azasi dan pidana selalu menghasilkan dua kubu pendapat yang sama-sama kuat yakni yang pro dan kontra. Kedua pandangan yang saling bertolak belakang tersebut memiliki argumentasi dan pertimbangan yang kuat menyangkut hukuman maksimal terhadap kejahatan istimewa. Negara-negara di dunia terbagi dua. Ada yang memilih opsi moratorium tetapi ada juga yang terus mempertahankannya. Artikel ini memaparkan secara deskriptif bahwa memang terdapat kesulitan-kesulitan substantif dalam setiap usaha legitimasi dan atau delegitimasi terhadap hukuman mati. Kesulitan-kesulitan tersebut dipaparkan dan dianalisis di dalam paper ini dengan menggunakan pendekatan teologis khususnya dalam persepektif hukum, hak hidup manusia dan perintah Alkitab untuk jangan membunuh. Analisis dilakukan secara dengan memanfaatkan tinjauan literatur dan hasil-hasil penelitian.

Parents As Decision-Makers — Do the Attitudes of Norwegian Doctors Conform to Law?

2011 ◽  
Vol 18 (5) ◽  
pp. 531-547 ◽  
Author(s):  
Marianne K. Bahus ◽  
Reidun Føerde
Keyword(s):  
End Of Life ◽  
Decision Makers ◽  
Best Interests ◽  
Final Decision ◽  
End Of Life Decisions ◽  
Legal Rules ◽  
Hypothetical Scenario ◽  
The Supreme Court ◽  
Surrogate Decision ◽  
The Right

AbstractThis article studies whether the attitudes of Norwegian doctors regarding surrogate decision power in end-of-life care conform to legal rules, particularly as they apply to the protection of children. The article is based on a hypothetical scenario concerning a critically ill child, believed to be dying, presented to 406 doctors. The study indicates that doctors may permit parental/surrogate decision-making to a greater extent than justified by law, sometimes in contravention of the child’s best interests, which should be a fundamental guideline in all decisions that concern children. This article suggests a need to improve knowledge of doctors concerning parents’/surrogates’ right to participate in life-or-death decisions. We conclude that Norway needs a precedent decision from the Supreme Court that confirms the right of judicial review of end-of-life decisions, and which applies the principle of the child’s best interests as a fundamental guideline in the final decision.

scholarly journals End-of-life Decisions for Patients with Prolonged Disorders of Consciousness in England and Wales: Time for Neuroscience-informed Improvements

2020 ◽  
Vol 30 (1) ◽  
pp. 73-89
Author(s):  
PAUL CATLEY ◽  
STEPHANIE PYWELL ◽  
ADAM TANNER
Keyword(s):  
Disorders Of Consciousness ◽  
Best Interests ◽  
Legal Rights ◽  
Persons With Disabilities ◽  
End Of Life Decisions ◽  
England And Wales ◽  
Mental Capacity Act 2005 ◽  
Life Sustaining Treatment ◽  
The Law ◽  
Mental Capacity Act

AbstractThis article explores how the law of England and Wales1 has responded thus far to medical and clinical advances that have enabled patients with prolonged disorders of consciousness to survive. The authors argue that, although the courts have taken account of much of the science, they are now lagging behind, with the result that some patients are being denied their legal rights under the Mental Capacity Act 2005. The article further argues that English law does not comply with the United Kingdom’s commitments under the United Nations Convention on the Rights of Persons with Disabilities. Stressing the need for the law to keep in step with advances in science, the article concludes with robust recommendations for improvements, based on the latest research in neuroscience, to the way in which life-sustaining treatment decisions are made. This would mean that the wishes of patients, including those with covert awareness, can be better reflected in best interests assessments.

scholarly journals Optimizing a Reverse Supply Chain Network for Electronic Waste under Risk and Uncertain Factors

2021 ◽  
Vol 11 (4) ◽  
pp. 1946
Author(s):  
Linh Thi Truc Doan ◽  
Yousef Amer ◽  
Sang-Heon Lee ◽  
Phan Nguyen Ky Phuc ◽  
Tham Thi Tran
Keyword(s):  
Supply Chain ◽  
Electronic Waste ◽  
Decision Makers ◽  
Reverse Supply Chain ◽  
Satisfactory Solution ◽  
Level Of Satisfaction ◽  
Proposed Model ◽  
Objective Value ◽  
The Right ◽  
The Impact

Minimizing the impact of electronic waste (e-waste) on the environment through designing an effective reverse supply chain (RSC) is attracting the attention of both industry and academia. To obtain this goal, this study strives to develop an e-waste RSC model where the input parameters are fuzzy and risk factors are considered. The problem is then solved through crisp transformation and decision-makers are given the right to choose solutions based on their satisfaction. The result shows that the proposed model provides a practical and satisfactory solution to compromise between the level of satisfaction of constraints and the objective value. This solution includes strategic and operational decisions such as the optimal locations of facilities (i.e., disassembly, repairing, recycling facilities) and the flow quantities in the RSC.

Medical treatment and best interests: judicial interpretation of values, wishes and beliefs under the Mental Capacity Act 2005

2020 ◽  
Vol 22 (3) ◽  
pp. 165-173
Author(s):  
Owen P. O'Sullivan
Keyword(s):  
Medical Treatment ◽  
Clinical Decision ◽  
Case Law ◽  
Decision Makers ◽  
Best Interests ◽  
Content Type ◽  
The Supreme Court ◽  
Mental Capacity Act 2005 ◽  
Mental Capacity Act ◽  
The Uk

Purpose The prominence of the best interests principle in the Mental Capacity Act 2005 represented an important transition to a more resolutely patient-centred model regarding decision-making for incapable adults (“P”). This paper aims to examine the courts’ consideration of P’s values, wishes and beliefs in the context of medical treatment, reflect on whether this has resulted in a wide interpretation of the best interests standard and consider how this impacts clinical decision makers. Design/methodology/approach A particular focus will be on case law from the Court of Protection of England and Wales and the Supreme Court of the UK. Cases have been selected for discussion on the basis of the significance of their judgements for the field, the range of issues they illustrate and the extent of commentary and attention they have received in the literature. They are presented as a narrative review and are non-exhaustive. Findings With respect to values, wishes and beliefs, the best interests standard’s interpretation in the courts has been widely varied. Opposing tensions and thematic conflicts have emerged from this case law and were analysed from the perspective of the clinical decision maker. Originality/value This review illustrates the complexity and gravity of decisions of the clinical decision makers and the courts have considered in the context of best interests determinations for incapacitated adults undergoing medical treatment. Subsequent to the first such case before the Supreme Court of the UK, emerging case law trends relating to capacity legislation are considered.

scholarly journals Company Changing Status and Its Linking to Competitiveness

2015 ◽  
Vol 53 (1) ◽  
pp. 1-17
Author(s):  
Dragana Radenković-Jocić ◽  
Ivan Barun
Keyword(s):  
Mergers And Acquisitions ◽  
Legal Framework ◽  
Decision Makers ◽  
Economic Activities ◽  
Economic Interests ◽  
Eu Legislation ◽  
The Republic ◽  
The Right ◽  
A Company ◽  
The Eu

Abstract The authors present the issues and challenges related to the changes in status of a company and its impact on competitiveness. Status changes of companies, mostly mergers and acquisitions of companies, are one of the ways in which capital owners and management direct economic activities with the aim of maximizing profits. In order to make the right and justified decision, in terms of achieving the economic interests of the company, it is essential to know the laws and regulations in this area. This paper should provide answers on various questions which will be presented to decision makers in every company, considering status changes. Bearing in mind that the question of status changes often associated with an international element, the authors will pay special attention on the EU legislation and current legal framework in the Republic of Serbia.

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