The legal basis for ethical withholding and withdrawing of life-sustaining medical treatment in children

Withholding and withdrawing life-sustaining medical treatment are common in paediatric practice, especially in intensive care units. However, not all clinicians apparently adhere to principles in ethical guidelines or to the principles which are to be found in judgments from common law cases arising when doctors and parents dispute treatment. This article examines selected ethical guidelines and compares them to judgments in leading cases. The rationale to forgo treatment is usually the child's "best interests" in both clinical practice guidelines and legal cases but in the former "best interests" may remain ill defined. Although "best interests" must essentially pertain to the individual child, the interests of others are not irrelevant. In legal cases "best interests" of the child are defined in terms such as "burden versus benefit", "futility", "indignity", "intolerability", "prolonging death rather than saving life" and "quality of life". These or like terms should form the basis of ethical decisions in discussions with parents when contemplating withholding or withdrawing life-sustaining treatment.     

Human rights, ethical principles, and standards in forensic psychology

Human rights create a protective zone around persons and allow them the opportunity to further their valued personal projects without interference from others. This article considers the relationship between human rights and the general ethical principles and standards contained in the American Psychological Association's (APA's) code of ethics as applied to the forensic domain. First, it analyzes the concept of human rights, their structure, and their justification. Second, it briefly describes the APA's most recent code of ethics and the principles and standards that compose it. Third, it concludes by explicitly examining the relationship between the present human rights model and the APA's code, demonstrating how it is able to provide an additional ethical resource for forensic practitioners in their clinical work and so deepen their ethical sensibilities and decision making. Finally, the article presents a case study and discusses the human rights issues confronting practitioners inherent in such situations.     

The medical provision of hydration and nutrition: two very different outcomes in Victoria and Florida

Decisions to withhold or withdraw medical hydration and nutrition are amongst the most difficult that confront patients and their families, medical and other health professionals all over the world. This article discusses two cases relating to lawful withdrawal and withholding of a percutaneous endoscopic gastrostomy tube (PEG) from incompetent patients with no hope of recovery. Victoria and Florida have statutory frameworks that provide for advance directives, however in both Gardner; Re BWV and Schindler v Schiavo; Re Schiavo the respective patients did not leave documented instructions. The article analyses the two cases and their outcomes from legal, medical and ethical perspectives.     

A line already drawn: the case for voluntary euthanasia after the withdrawal of life-sustaining hydration and nutrition

When life-sustaining hydration and nutrition is withheld from an incompetent and immobile patient like Terri Schiavo, death comes to the patient by dehydration within about two weeks. Americans should be permitted to arrange for euthanasia at that point, as opposed to merely dehydrating to death, and should be able to incorporate their desire for euthanasia into an advance directive. A state constitutional right of privacy could provide the legal avenue permitting effectuation of such a choice.