The American Journal of Bioethics, Volume 11, Issue 7, Page 18-20, July 2011.

It is often claimed that managed care organizations involve physicians in conflicts of interest by creating financial incentives for physicians to refrain from ordering treatments or making referrals. Such incentives, the argument goes, force the physician to balance the patient's health interests against the MCO's interests and the physician's own financial interest. I assume, for the sake of argument, that such arrangements at least provide reason to believe that physicians in MCOs are involved in conflicts of interest. Two approaches have (...) evolved for dealing with these conflicts. On one approach, MCOs disclose the financial arrangements under which their physicians work so that patients can consent to the managed care plan and thereby to the plan's limitations. The chief proponent of this approach is Mark Hall, whose recent book Making Medical Spending Decisions applies prior consent to a variety of decisions regarding medical financing and allocation. The other approach is simply to forbid conflicts of interest through regulations. (shrink)

The Supreme Court, reluctant to find constitutional rights in areas marked by divisive social and legal debate, is not likely to constitutionalize a right to assisted suicide. The Court should cleave to the tradition of discouraging suicide and criminalizing its assistance.

In “What is Wrong with Rational Suicide,” Pilpel and Amsel develop a counterexample that allegedly confounds attempts to condition the moral permissibility of suicide on its rationality. In this counterexample, a healthy middle aged woman with significant life accomplishments, but no dependents, disease, or mental disorder opts to end her life painlessly after reading philosophical texts that persuade her that life is meaningless and bereft of intrinsic value. Many people would judge her suicide “a bad mistake” despite its meeting “robust” (...) conditions for rationality. Hence, Pilpel and Amsel conclude, even robust conditions for the rationality of suicide “fail to do their job: to exclude intuitively unacceptable suicides from being permissible.” I argue here that this counterexample fails to cast doubt on philosophical attempts to account for the moral permissibility of suicide in terms of its rationality. (shrink)

The American Journal of Bioethics, Volume 11, Issue 7, Page 20-22, July 2011.

Many people believe that it is permissible for people who are suffering from terminal illnesses to commit suicide or even that such people have a right to commit suicide. Some have also argued that it follows that it is permissible for them, or that they have a right, to use the assistance of another person. First, I assume that it is permissible for a person to commit suicide and ask whether it follows that it is also permissible for the person (...) to employ an agent to assist in the death. Second, I assume that people have a right to commit suicide and ask whether it follows that the right holders have a right to employ an agent to assist with the death. I argue that the permissibility of suicide does not by itself entail the permissibility of employing someone to assist in the suicide. I also argue that the right to commit suicide does not by itself entail the right to assisted death. Instead, what follows is that there is a right not to have unreasonable restrictions placed on the means by which one can exercise one's right to commit suicide. Whether a restriction is reasonable depends on the conclusion reached when one has weighed a number of policy considerations. (shrink)

Prior to passage of the Oregon Death with Dignity Act, opponents of assistance in dying argued that legalization would have serious harmful consequences. Specifically, they argued that the quality and availability of palliative care would decline, that the harms of legalization would affect certain vulnerable groups disproportionately, that legal assisted dying could not be confined to the competent terminally ill who voluntarily request assistance, and that the practice would result in frequent abuses. Data from Oregon's decade-long experience decisively refute the (...) first three predictions. As to abuses, the record is not quite as clear, but if an appropriate framework for analysis is utilized, the most reasonable conclusion is that the risks of abuse do not outweigh the benefits of legalization. To the extent projected harmful consequences are relevant to the debate over legalization, Oregon's experience argues in favor of legalization of assistance in dying. (shrink)

In the present article the concept of the right to die will be analyzed in English and American literature between 1990 and 1994.

Western ethics and law have been slow to come to conclusions about the right to choose the time and manner of one's death. However, policies, practices, and legal precedents have evolved quickly in the last quarter of the twentieth century, from the forgoing of respirators to the use of Do Not Resuscitate (DNR) orders, to the forgoing of all medical technologies (including hydration and nutrition), and now, in one U.S. state, to legalized physician-assisted suicide. The sweep of history—from the Quinlan (...) case in New Jersey to legislation in Oregon that allows physician-assisted suicide—has been as rapid as it has been revolutionary. (shrink)

As of 2019, ten jurisdictions in the United States—Oregon, Washington, Montana, Vermont, California, Colorado, the District of Columbia, Hawaii, New Jersey, and Maine—have authorized physicians to...

It has been proposed that an old and ill person may have a ‘duty to die’, i.e. to refuse life-saving treatment or to end her own life, when she is dependent on the care of intimates and the burdens of care are becoming too heavy for them. In this paper I argue for three contentions: (1) You cannot have a strict duty to die, correlating to a claim-right of your relatives, because if they reach the point at which the burdens (...) of care are larger than you can reasonably expect them to take, the natural conclusion is that their duty ends. (2) They may be prepared, however, to go on caring for you beyond that point. In that case your responsibility for their wellbeing may require you to refuse this care, even if this results in a situation for you in which death will be preferable to continued life. (3) If this is the correct understanding of your responsibilities, the objection that in the context of family life the burdens of care attached to one family member’s valued existence can never be ‘too heavy’, fails. It postulates unlimited concern on one side and a total lack of concern on the other. (shrink)