Showing papers by "George J. Annas published in 1987"

Protecting the liberty of pregnant patients.

Abstract: WE are seeing the beginning of an alliance between physicians and the state to force pregnant women to follow medical advice for the sake of their fetuses.1 No irreversible commitments to such an a...

At Law: Siamese Twins: Killing One to Save the Other

Abstract: KIE: The birth of Siamese twins joined at the chest (thoracopagus twins) and sharing a heart creates an ethical dilemma Infants with conjoined hearts survive no more than a few months, and physicians must decide whether to give one child a chance at life by separating the twins and sacrificing one to give the other an intact heart Annas reviews the ethical and legal discussions generated by the birth and treatment of thoracopagus twins at Philadelphia's Children's Hospital in 1977 and 1987 He considers most of the analogies used to justify the death of one twin to be strained The situation becomes more complicated when there is no medical indication as to which twin has a better chance of surviving Nevertheless, Annas concludes that the bleakness of the twins' prognosis if they remain joined justifies separation and the death of one child, despite the difficulty of developing a rationale for the act

Baby M: babies (and justice) for sale.

Abstract: A professor of health law criticizes the decisions of New Jersey Superior Court Judge Harvey R. Sorkow which culminated in his awarding permanent custody of Baby M to her biological father, William Stern. Annas quotes from the In re Baby M decision and from the contract between Stern and his wife and surrogate mother Mary Beth Whitehead to support his contention that Sorkow \"rendered a sermon filled with contradictions, double-standards, inapt analogies, and unsupported conclusions.\" He argues that legally Mrs. Whitehead could not have prospectively waived her right to rear a child she bore, that Sorkow was biased in favor of the \"upper-middle-class Sterns,\" and that consideration should be given to returning Baby M to Mrs. Whitehead. He urges state legislatures to outlaw the sale of children, to affirm the legal status of the gestational mother, and to forbid a surrogate's relinquishment of parental rights until after her child's birth.

At law. Transferring the ethical hot potato.

Abstract: Annas applauds the reversal on appeal of three court decisions in which trial court judges sided with hospitals that refused to accede to the wishes of nonterminally ill patients to reject life-sustaining treatment. The appellate decisions he discusses are Bartling v. Superior Court (163 Cal.App.3d 186 [1984], Bouvia v. Superior Court (179 Cal.App.3d 1127 [1986]), and Brophy v. New England Sinai Hospital (497 N.E.2d 626 [Mass., 1986]). He also praises the \"enlightened approach\" taken recently by a New Jersey trial court judge (In re Requena, Morris Co., P-326-86E, 24 Sep 1986) in turning down a hospital's request for a court order to transfer a patient who refused tube feeding. \"If hospitals are to become the humane institutions they often claim to be,\" argues Annas, \"they must remain flexible enough to honor the competent wishes of their patients without forcing them to return home or engaging in 'ethical dumping' by transferring them to other institutions.\"

Routine prenatal genetic screening.

Abstract: Standards of medical practice have traditionally been set by physicians on the basis of their best judgment of what constitutes good patient care. This tradition is in danger. The structure of medical practice — factors such as cost containment, the profit motive, government regulations, fear of medical-malpractice suits, media hype, and risk-management schemes — may influence actual practice more than professional standards. Whether a prenatal screening test is offered may depend as much on the patient's health insurance and the physician's perception of possible legal liability as on the physician's view of the patient's welfare. There is widespread ethical, legal, . . .

From Canada with love: anencephalic newborns as organ donors?

Abstract: The case of Baby Gabriel--a Canadian anencephalic newborn whose heart was transplanted posthumously into an infant at Loma Linda University Medical Center in California after his parents chose to proceed with his birth and with efforts to prolong his life so that his organs could be transplanted--serves as a springboard to discuss the law and morality of using anencephalic newborns as organ sources. The central policy choice is whether such use should be abandoned because there is currently no clinically accepted means to determine brain death in these infants, or whether research should be undertaken to establish valid criteria for declaring death in anencephalic newborns and to determine how these infants fare with ventilator support. Such research is underway in Canada although it is blocked in the U.S. by federal regulations.

The impact of medical technology on the pregnant woman's right to privacy.

Abstract: PIP: It has been suggested that the advance of science and technology in the West has changed both the relationship of man to nature and of man to man. With regard to human reproduction, science and technology in medicine may certainly change the relationship of man to nature and of man to man, but also the concept of what it means to be human. Efforts must be taken to guarantee the rights of all humans. The author explores developing reproductive medical technology to consider how it may change our concept of humanness and how that change may be accommodated, encouraged, or impeded by the relationship between the government and its pregnant citizens as defined by the US Constitution and the right to privacy. Sections discuss the Constitution at the beginning of life; sterilization and the right to procreate; contraception, abortion, and the right not to procreate; and surrogacy. The author also discusses constitutional issues when the interests of a pregnant woman conflict with those of the fetus in terms of fetal surgery, forced cesarean-section cases, and the fetal abuse case of Pamela Monson Stewart.

Trying to Live Forever

Abstract: Book Reviews in This Article: Andrew H. Malcolm, This Far and No More: A True Story. The Hastings Center, Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying. New York State Task Force for Life and the Law, Life-Sustaining Treatment: Making Decisions and Appointing a Health Care Agent. Daniel Callahan, Setting Limits: Medical Goals in an Aging Society.

In thunder, lightning or in rain: what three doctors can do.

Abstract: Annas discusses three 1987 New Jersey Supreme Court cases in which the court decided that life-sustaining treatment could be terminated either because this was what the patient clearly wanted (In re Farrell and In re Peter) or because it was the family's best judgment of what the patient wanted (In re Jobes). He is critical of the court's opinions because they appear to place limits on the right to refuse treatment through the use of procedural \"rules.\" By categorizing patients in terms of, for example, being in a persistent vegetative state, and by requiring medical consultations in cases involving refusal of life-sustaining treatment, the court followed the Quinlan precedent of focusing on decision making by physicians.