Reflections

Journal of General Internal Medicine, Jul 2013

Joseph Fletcher

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Reflections

JOURNALOFGENERALINTERNALMEDICINE JOSEPH FLETCHER Morals a n d M e d i c i n e : • . . the p a t i e n t ' s right to k n o w the t r u t h [re] c o n t r a c e p t i o n , artificial i n s e m i n a t i o n , sterilization, e u t h a n a s i a P r i n c e t o n U n i v e r s i t y Press, 1954 - REFLECTIONS T h e r e is g r e a t w i s d o m a n d m o r a l a s s u r a n c e i n t h e d e c i s i o n of C h a r l o t t e P e r k i n s G i l m a n , o n e of A m e r i c a ' s g r e a t e s t w o m e n , w h o c h o s e s e l f - e u t h a n a s i a r a t h e r t h a n e n d u r e a d e g e n e r a t i v e d e a t h b y c a n c e r . T h e s e w e r e h e r l a s t w o r d s , t y p e d b y h e r o w n h a n d : "A l a s t duty. H u m a n life c o n s i s t s in m u t u a l service. No grief, n o p a i n , m i s f o r t u n e or ' b r o k e n h e a r t ' is e x c u s e for c u t t i n g off o n e ' s life w h i l e a n y p o w e r of s e r v i c e r e m a i n s • But w h e n a l l u s e f u l n e s s is over, w h e n o n e is a s s u r e d of a n i m m i n e n t a n d u n a v o i d a b l e d e a t h , it is the s i m p l e s t of h u m a n r i g h t s to c h o o s e a q u i c k a n d e a s y d e a t h i n p l a c e of a s l o w a n d h o r r i b l e one. P u b l i c o p i n i o n is c h a n g i n g on t h i s s u b j e c t . The t i m e is a p p r o a c h i n g w h e n w e s h a l l c o n s i d e r it a b h o r r e n t to our c i v i l i z a t i o n to a l l o w a h u m a n b e i n g to lie i n p r o l o n g e d a g o n y w h i c h w e s h o u l d m e r c i f u l l y e n d in a n y other c r e a t u r e . B e l i e v i n g this c h o i c e to b e of s o c i a l s e r v i c e i n p r o m o t i n g w i d e r v i e w s o n this q u e s t i o n , I h a v e p r e f e r r e d chloroform to c a n cer." 1. Besdine RW . Decisions to withhold treatment from nursing home residents . J Am Geriatr Soc 1983 ; 31 : 602 - 6 2. Pearlman RA , Jonsen A . The use of quality of life considerations in medical decision-making . J Am Geriatr Soc 1985 ; 33 : 344 - 52 3. Lo B , Jonsen AR. Clinical decisions to limit treatment . Ann Intern Med 1980 ; 93 : 764 - 8 4. Pearlman RA , Inui TS , Carter WB . Variability in physician bioethical decision-making: a case Study of euthanasia . Ann Intern Med 1982 ; 97 : 420 - 5 5. Uhlmann RF , MacDonald WJ , lnui TS . Epidemiology of no-code orders in an academic hospital . West J Med 1984 ; 140 : 114 - 6 6. Deker RB , Blidner IN , Carr LM , Barnsley JM , The impact of selected patient characteristics on practitioners' treatment recommendations for end stage renal disease . Med Care 1985 ; 23 : 95 - 108 7. Campbell A , Converse PE , Rodgers WL . The quality of American life perceptions, evaluations and satisfactions . New York: RusselSage, 1976 8. Flanagan JC . Measurement of quality of life: current state of the art . Arch Phys Med Rehabil 1982 ; 63 : 56 - 9 9. Spitzer WO , Dobson AJ , Hall J , et al: Measuring the quality of life of cancer patients . J Chronic Dis 1981 ; 34 : 858 - 97 10. Bedell SE , Delbanco TL . Choices about cardiopulmonary resuscitation in the hospital . N Engl J Med 1984 ; 310 : 1089 - 93 11. Crane D. The sanctity of social life: physician's treatment of critically ill patients . New York: RusseI Sage, 1975 12. Brown NK , Thompson DJ . Nontreatment of fever in extended care facilities . N Engl J Med 1979 ; 300 : 1246 - 50 13. Good MDV , Good B . Patient requests in primary care clinics . In: Christman NJ , Maretzki TW (eds): Clinically applied anthropology. Dordrecht, Holland, D. Reidel Co , 1982 ; 275 - 96 14. Nie NH , Hull CH , Jenkins JG , Steinbrenner K , Bent DH . Statistical package for the social sciences ,2nd ed. New York: McGraw-Hill , 1975 15. Prigatano GP , Wright EC , Levin D. Quality of life and its predictors in patients with mild hypoxemia and chronic obstructive pulmonary disease . Arch Intern Med 1984 ; 144 : 1613 - 9 16. Ahlsio B , Britton M , Murray V , Theorell T. Disablement and quality of life after stroke . Stroke 1984 ; 15 : 886 - 90 17. President 's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Making health care decisions: the ethical and legal implications of informed consent in the patientpractitioner relationship . Washington, DC: Library of Congress, 1982 , p 38 18. Thomasma DC . Ethical judgments of quality of life in the care of the aged . J Am Geriatr Soc 1984 ; 32 : 525 - 7 19. Loomis MT , Williams TF . Evaluation of care provided to terminally ill patients . Gerontologist 1983 ; 23 : 493 - 9 20. Ajzen I , Fishbein M . Attitude-behavior relations: a theoretical analysis and review of empiric research . Psychol Bull 1977 ; 84 : 888 - 918


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Joseph Fletcher. Reflections, Journal of General Internal Medicine, 2018, 379-379, DOI: 10.1007/BF02596421