Thursday, October 06, 2005

Two items side by side...

The Supreme Court is considering Oregon's assisted suicide law...

WASHINGTON, Oct. 5 - The question of assisted suicide reached the Supreme Court for the second time in eight years on Wednesday, although the profound issues of professional ethics and personal autonomy that have animated the national debate largely remained outside the courtroom.

nstead, lawyers for the federal government and for Oregon, the only state to have authorized physician-assisted suicide, argued over a single question: whether John Ashcroft acted within his authority as attorney general when he decided in 2001 that doctors would lose their federal prescription privileges if they followed the Oregon law's procedures and prescribed lethal doses of lawful medications for terminally ill patients who wanted to end their own lives.

This is a straightforward question of federal administrative law, the bread and butter of the Supreme Court's docket. A federal appeals court ruled last year that in enacting the Controlled Substances Act in 1970, Congress did not give the attorney general the unilateral authority to penalize doctors who follow state law in prescribing federally regulated medications. The case, now known as Gonzales v. Oregon, No. 04-623, is the Bush administration's appeal.

Chief Justice John G. Roberts Jr. was an active participant in the questioning. He asked Solicitor General Paul D. Clement, who was defending the Ashcroft action, for "the closest analogy you have, other than this case," in which the attorney general had "impinged on" a state regulation of medical practice.

When Mr. Clement began to describe the Food and Drug Administration's effort some years ago to stop the use of laetrile, an anticancer drug that was permitted in 17 states, Chief Justice Roberts cut him off. "That's the F.D.A.," he said. "I'm talking about the attorney general under this statute."

Mr. Clement, an admired Supreme Court advocate who speaks without notes, at first said he could not think of an example. Then he offered the government's prohibition against using marijuana for medical purposes, which the Supreme Court upheld in June.

This drew an objection from Justice David H. Souter, who said that Congress's desire to stop "drug pushing and drug abuse in the conventional sense" did not support the government's position on assisted suicide.

Greensmile's post, where he quotes this recent study...

In the study, 20 participants 10 to 20 years old being treated at either St. Jude or Sydney Children's Hospital participated in one of three end-of-life decisions: enrollment on a Phase I study of a drug that would not benefit them in their terminal stage (seven patients); adoption of a "do-not-resuscitate [DNR]" order (five patients), or initiation of terminal care, i.e., aggressive treatment of disease symptoms rather than the disease itself (eight patients).

A striking finding was that consideration of others' preferences was the factor most frequently reported to affect decision making by patients, parents and physicians, Hinds said. This indicates that human relationships strongly influence end-of-life decisions in pediatric oncology, she added.

Another key finding was that, among 11 of the 20 patients, a part of the decision-making process included the wish to benefit others, even though they themselves would not benefit. The St. Jude investigators say they did not anticipate this finding since such behavior is not reflected in existing theories of child development, which maintain that children expect personal benefit when they help someone else. ...

Young patients who wanted to end all therapy, even if that therapy might extend their lives (65 percent), came to that decision because of "wanting no more," the researchers report. For example, a 15-year-old girl with acute lymphoblastic leukemia said, "We decided not to go with chemo because I don't want to be sick the rest of my days, and it's not like it is going to cure me, so I just said, 'We'll go home and take it from there.'" Other patients said they were ready to die and go to heaven (50 percent) or that they had seen other patients die on mechanical support and wanted to avoid that course of treatment (50 percent).

Clinicians see this type of research as a priority because they often feel unprepared to offer adequate assistance to parents and patients during this time, according to Wayne Furman, M.D., a member of the Department of Hematology-Oncology and deputy director of the Solid Tumor Clinic.

"Knowing what their child's end-of-life care preferences are would let parents and clinicians honor them where possible," said Furman, the paper's senior author. "This could provide comfort to parents after the loss of their child and reassure clinicians about the quality of care they provide. It might also give patients a sense of control during a time when most decisions are not within their control."

Greensmile's point is dead on:

If kids can make sound and generously humane decisions about their own end-of-life,

I think, unfortunately, the answer is simple: Because there's more power and money to be gained by making political footballs out of the dying, to get political support based on the pro-suffering morality of the anti-human life crowd (that is, the zygotes=brain dead people=living people crowd).

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