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The Politics of Palliative Care and the Ethical Boundaries of Medicine: Gonzales v. Oregon as a Cautionary Tale

Published online by Cambridge University Press:  01 January 2021

Extract

The 2006 term of the United States Supreme Court is now well underway, and the results of the congressional mid-term elections are in. No doubt, decisions will be handed down and national legislation proposed – perhaps even enacted – that will directly or indirectly affect the physician-patient relationship as well as the profession of medicine itself. Of major concern to physicians, patients, and the lay public is the ongoing, rather contentious debate surrounding both patient access to adequate pain control and what constitutes proper physician conduct in treating patients who are experiencing either chronic or end stage disease pain. Those knowledgeable in palliative medicine maintain that an “epidemic of undertreated pain” now exists, and probably has existed for more than a decade. A significant number of patients experience unnecessary pain and suffering, and this disturbing phenomenon is both an individual patient care problem and a public health concern.

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Independent
Copyright
Copyright © American Society of Law, Medicine and Ethics 2007

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References

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While it is beyond the scope of this article, I would argue that Supreme Court justices should make at least an attempt to acquaint themselves with the basics of medical ethics. As the last several years have demonstrated, ignorance of and indifference to the fundamentals of medical ethics have contributed to several justices making some rather strange and problematic assertions. An excellent starting point for making a case for justices learning more about ethical reasoning and ethical concepts is Justice Scalia's closing statement in his dissent in Oregon.Google Scholar
While it is true that Justice Kennedy, the author of the majority opinion in Oregon, joined Justice Rehnquist in his opinions for the Court in Cruzan and Glucksberg without filing an opinion of his own in either case, the other members of the majority in Oregon have had occasion to share their views on patient suffering at the end of life, physician intentions in treating that suffering, and state and federal interference with physicians' actions and patients' autonomous wishes. I think it is fair to say that many of these justices are sympathetic toward laws and policies that would allow physicians to aggressively treat pain, even if such treatment hastened death.Google Scholar
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