CHEST Guidelines-Deconstructing-the-Code-of-Medical-Ethics-and-Prac

Deconstructing-the-Code-of-Medical-Ethics-and-Prac

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The document discusses a critical analysis of medical ethics and practices in end-of-life care within pluralistic societies. It highlights a discourse based on an article by Bosslet et al., published in the journal CHEST, which examines how the United States, Canada, and the United Kingdom handle end-of-life care disputes, particularly focusing on the reasons given for decisions to cease life-sustaining treatment.<br /><br />The authors, Rady and colleagues, argue that there is a limited public discourse in the US concerning ethical decisions in end-of-life care, with prominent legal cases such as Vacco v Quill and Washington v Glucksberg providing foundational reasoning against seeing medically assisted death as a constitutional right. They critique the narrow interpretation of patient autonomy and best interest, suggesting that these are often assessed by external agents based solely on quality-of-life criteria, which may violate deeply held cultural or religious values.<br /><br />The response from Bosslet and colleagues acknowledges these points but clarifies that their original focus was on nonconsensual recommendations to terminate life-supporting treatments rather than on medically assisted dying. They also note that the McMath case, which challenges traditional medical definitions of brain death, could influence future societal and medical discourse.<br /><br />Both parties agree on the importance of legislative initiatives over judicial decisions to impact social discourse more effectively. They highlight Ontario's Health Care Consent Act as an example of legislation that provides structured, case-by-case reasoning, promoting clearer social and clinical guidance. This conversation is crucial as it emphasizes the need for a balanced approach, integrating medical ethics with societal values to navigate complex end-of-life decisions in diverse cultural contexts.

Keywords

medical ethics

end-of-life care

pluralistic societies

Bosslet et al.

life-sustaining treatment

patient autonomy

cultural values

McMath case

Health Care Consent Act

legislative initiatives