UK's 'right-to-die'card stirs controversy
Card is available in public places
One individual in the UK, who happens to be on the Salford City Council in Great Britain, has introduced what is being called the "right-to-die card" in that country and has set off a controversy among those in the Christian pro-life movement and those who choose it as a way to make their wishes known in the event they are incapacitated due to sudden injury or illness.
According to a BBC magazine report, those against the card, which is available in many public places including pubs, banks and libraries, say it could lead to euthanasia. Those who support the card say it is a useful way to implement that country's Mental Capacity Act, implemented in 2007, which allows adults to draw up advance directives, the report said.
The card is meant to be carried with the person, and is intended to direct caregivers to detailed instructions, typically with relatives, friends or their usual physician, regarding what to do if they are no longer able to make decisions about their health care in life-threatening situations, the BBC reported.
But before ethicists or the public anticipate this idea leaping across the pond, at least one bioethicist suggests that the procedures and processes already in place in the United States provide sufficient alternatives for patients in such situations.
"It's not so different," says Art Derse, MD, JD, director, Medical and Legal Affairs, Center for the Study of Bioethics, Medical College of Wisconsin, in Milwaukee.
Derse notes that patients in the United States have a similar approach in two categories: the pre-hospital Do Not Resuscitate (DNR) orders; and a document referred to as POLST (Physicians Orders Concerning Life-Sustaining Treatment).
DNR orders "are physicians' orders not to resuscitate that have been made by a physician that is information to paramedics or EMTs when they come to an emergency situation," Derse explains.
These two documents, as well as other legal documents available, can spell out what the patient's wishes are for the emergency medical system.
"Our advantage here in the United States is that they are physicians' orders that are arrived at with the patient in agreement," Derse says. "In Great Britain, it does not appear as if you must have a physician as someone who's actually agreeing with, or actually giving an order, so it does make it more difficult.
The difficulty, he said, exists because patients often don't know what's going to happen until resuscitation is attempted.
"When someone decides that a patient ought not to be resuscitated, it's really looking at prognosis, so you wouldn't want a healthy young person carrying this card in their back pocket, without any underlying medical problem, just because they think, 'Well, it's possible that I could end up in a state that I don't want to be [in], so I'm going to carry one of these cards around,'" Derse says. "On the other hand, a card like this might be extremely appropriate for someone who's got terminal cancer and does not want resuscitation."
Another danger with such a card is the possibility that the card could be separated from the person to whom it actually belongs, particularly in an emergency situation, leading to potentially withholding treatment for the wrong person, Derse says.
John Moskop, PhD, a professor of medical humanities at the Brody School of Medicine at East Carolina University, as well as director of the bioethics center at the University Health Systems of Eastern Carolina in Greenville, SC, said he would be against such cards being available in the United States.
"Although I am a strong advocate for advance care planning and advance directives, especially health care powers of attorney, I would not favor introduction of a card like the one described," Moskop says. "The main reason is that I don't believe that these cards would be a reliable way for people to convey their wishes regarding medical treatment."
He cites the disadvantages of the card's small size, thus allowing them to carry limited information about care, i.e., a "yes" or "no" request.
"In fact, very few people would choose either to accept or refuse all treatment," Moskop says. "Instead, most people want treatment under certain circumstances and not under other circumstances, but a small card would not be able to communicate these more complex wishes."
Another fact he cites is the fact that the card is apparently intended primarily for use in emergency situations, when "it is most difficult to determine whether treatment can be successful."
Sources
For more information, contact:
- Art Derse, MD, JD, professor of bioethics and emergency medicine, Medical College of Wisconsin, Milwaukee, WI. Phone: (414) 456-8498. E-mail: [email protected].
- John Moskop, PhD, professor of medical humanities, Brody School of Medicine at East Carolina University, Greenville, NC, 27834. Phone: (252) 744-2361. E-mail: [email protected].
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