The removal of life-sustaining treatment often brings physicians into conflict with patients. Because of their moral beliefs physicians often respond slowly to the request of patients or their families. People in bioethics have been quick to recommend that in cases of conflict the physician should simply sign off the case and “step aside”. This is not easily done psychologically or morally. Such a resolution also masks a number of more subtle, quite trouble some problems that conflict with the commitment to (...) toleration and moral diversity that it is intended to support. These conflicts are detailed and evaluated. (shrink)

The randomization ingredient in double-blind controlled experiments may be objectionable to patients who, in their desperation, come to such trials seeking a last chance of cure. Minogue et al., who view such a situation as inherently exploitive and undermining of patient autonomy, propose that such “desperate volunteers” instead be enrolled in the active arm, while other patients, less desperate and more committed to medical progress, continue to be randomized. Their view is critiqued as destructive of medical progress, inappropriate in its (...) lack of clinical response to such patients, and fatally flawed by unrealistic notions of autonomy and voluntariness. (shrink)