This article reviews the medieval law background of the parens patriae jurisdiction of the state as it has been exercised over incompetent persons who formerly were competent adults, concluding that the fiduciary standard implied in the statute De Prerogative Regis (1324), which is the basis for modern guardianship status, requires that the court and guardian adopt an attitude of respectful friendship toward the incompetent person, just as though they were to be accountable to the person himself, were he to recover (...) his faculties and become competent once more. This ficuciary responsibility, originating in the device of the "use" or trust employed for the management of the estates of lunatics, contrasts with the self-interested feudal guardianship used for the custody of "natural fools" or "idiots", who were under paternalistic arrangements. The article argues that because the determination of legal incompetence and the consequent transfer of custody of the person and property of an incompetent person to the state would result in a drastic forfeiture of liberty and property interests were it not for the fiduciary obligation owed by the state to the incompetent, the state is under an obligation to exercise its fiduciary duties in good faith and may not impose states policies or advance state interests of its own in the supervision of the affairs of incompetent persons, apart from interests arising legitimately out of the state's institutional interest in providing competent administration for the benefit of the incompetents themselves. Keywords: concept of the person, Cruzan, feudalism, guardianship, incompetent person, parens patriae CiteULike Connotea Del.icio.us What's this? (shrink)

Aruna Ramachandra Shanbaug breathed her last after 42 years of being in a persistent vegetative state. Euthanasia in any form is not permitted in India and it was only in the year 2011 that a petition was filed in the court that urged the cessation of her force feeding with a nasogastric tube and the request for her peaceful death. What followed was a string of arguments and counter arguments relating to Euthanasia. The sad demise of Aruna Shanbaug is not (...) the end of an individual, but may be the end of the road for clear cut guidelines and legislation on Euthanasia in India. (shrink)

BackgroundAn important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians (...) to report euthanasia to a review committee. We studied which arguments Dutch physicians use to substantiate their adherence to the criteria and which aspects attract review committees' attention.MethodsWe examined 158 files of reported euthanasia and physician-assisted suicide cases that were approved by the review committees. We studied the physicians' reports and the verdicts of the review committees by using a checklist.ResultsPhysicians reported that the patient's request had been well-considered because the patient was clear-headed (65%) and/or had repeated the request several times (23%). Unbearable suffering was often substantiated with physical symptoms (62%), function loss (33%), dependency (28%) or deterioration (15%). In 35%, physicians reported that there had been alternatives to relieve patients' suffering which were refused by the majority. The nature of the relationship with the consultant was sometimes unclear: the consultant was reported to have been an unknown colleague (39%), a known colleague (21%), otherwise (25%), or not clearly specified in the report (24%). Review committees relatively often scrutinized the consultation (41%) and the patient's (unbearable) suffering (32%); they had few questions about possible alternatives (1%).ConclusionDutch physicians substantiate their adherence to the criteria in a variable way with an emphasis on physical symptoms. The information they provide is in most cases sufficient to enable adequate review. Review committees' control seems to focus on (unbearable) suffering and on procedural issues. (shrink)

In Memory of Ed PellegrinoEuthanasia in Belgium is not limited to terminally ill patients. It may be applied to patients with chronic degenerative diseases. Currently, people in Belgium wish to make it possible to euthanize incompetent patients who suffer from dementia. This article explains the Belgian law and then explores arguments for and against euthanasia of patients with dementia. It probes the dementia paradox by elucidating Dworkin’s distinction between critical and experiential interests, arguing that at the end-of-life this distinction is (...) not clearcut. It argues against euthanasia for patients with dementia, for respecting patients’ humanity and for providing them with more care, compassion, and good doctoring. (shrink)

The Groningen protocol allows for the euthanasia of severely ill newborns with a hopeless prognosis and unbearable suffering. We understand the impetus for such a protocol but have moral and ethical concerns with it. Advocates for euthanasia in adults have relied on the concept of human autonomy, which is lacking in the case of infants. In addition, biases can potentially influence the decision making of both parents and physicians. It is also very difficult to weigh the element of quality of (...) life on the will to live. We feel an important line has been crossed if the international medical community consents to the active euthanasia of severely ill infants and are concerned about the extension of the policy to other at risk groups. (shrink)