HEALTH ETHICS TODAY

Volume 11, Number 1, February 2000

Editor's Forum

Al-Noor Nathoo
Executive Director and Southern Alberta Coordinator
Provincial Health Ethics Network, Alberta

Recently, the case of Andrew & Helene Sawatzky, in which a Winnipeg woman initiated court proceedings to have a 'Do Not Resuscitate' order removed from her husband's medical chart, brought to the public eye a long-standing controversy regarding value differences between health care recipients and providers. Stemming from the theme of the 1999 Annual Conference of the Provincial Health Ethics Network (PHEN), this issue of Health Ethics Today explores various forms that such disagreements often take. These include the enduring controversy surrounding so-called 'non-beneficial' or 'futile' treatments, conflicting opinion regarding the best of various alternative courses of therapy, and questions of best interest or substituted judgment when care recipients are incapable of making or expressing informed judgments.

While relatively few, if any, topics in bioethics lend themselves to being resolved with relative ease, the questions addressed in this issue have proven to been particularly problematic and vexing. They involve issues of resource allocation, respect for culture, limits of patient autonomy, the dangers of conflating medical determinations and value judgments, and the difficulty involved in achieving an appropriate balance between individual preference and social good. In addition to thought-provoking summary pieces by conference speakers Alister Browne and Ted Keyserlingk, the popular case study format is used by Stan Whitsett and Kathy Oberle to engage similar issues, with added twists of disagreements between health care providers and even (!) between ethics committees. Chip Doig and Randall Sargent round out the issue with thorough reviews - one from an acute care and the latter from a long-term care provider perspective - on the recent publication of American Bioethicist Susan Rubin's When Doctors Say No: The Battleground of Medical Futility.

As always, we welcome reader's comments and reactions to the thoughts expressed in these pages, as part of our continued efforts to turn 'mono-' into 'dia-' logue.

Contents

• Editor's Forum (Al-Noor Nathoo)
• When When Patients Demand Too Much (Alister Brown)
• Talking About "Futility" to Families of Dying Patients: The Scope and Limits of Medical Judgment (Edward W. Keyserlingk)
• Defining "Good" in Pediatric Cases (Kathleen Oberle & Stan F. Whitsett)
• Book Reviews - When Doctors Say No: The Battleground of Medical Futility (Randall Sargent, Christopher James Doig)
• The Fabric of Goodness
  Leadership for the New Millennium: Ethics 2000
  Summer Seminar in Health Care Ethics
  13^th World Congress on Medical Law

Health Ethics Today Credits

Editorial Committee:

Health Ethics Today is produced by the John Dossetor Health Ethics Centre, University of Alberta and the Provincial Health Ethics Network.

The opinions expressed in this newsletter are those of the authors only and not necessarily those of the John Dossetor Health Ethics Centre or the Provincial Health Ethics Network.