As Coroner, I must aver I thoroughly examined her And she’s not only MERELY dead, She’s really, most SINCERELY dead. —Coroner, after examining the remains of the Wicked Witch of the East. The Coroner reassures the social representative, the mayor, and the legal, ethical, and spiritual representatives in the Land of Oz. From the film The Wizard of Oz , 1939. Few duties of the physician are more difficult than explaining to a family that a loved one has died. This task becomes particularly delicate when death is diagnosed by neurologic criteria. The Council on Ethical Affairs of the California Medical Association (CEA) has developed this topic into a policy and procedure that detail a practical approach to address ethical and social issues encountered at the bedside when physicians diagnose death (see supplementary web material available at www.neurology.org).1 In this article, some of the authors of that policy expand on the section concerning behavior of professional staff toward the family of an individual whose cardiopulmonary support will be withdrawn after a diagnosis of neurologic death. We recommend a more direct conversation with family members than sometimes occurs and offer a model for this sensitive exchange. We organize our discussion around a scene from the 1939 movie The Wizard of Oz because this film contains a memorable and succinct exposition of the elements most reassuring in and essential to a declaration of death. In using this example, we do not mean in any way to diminish the anguish, responsibility, and mystery associated with the passing of loved ones. This scene begins after Dorothy and her house have fallen on the Wicked Witch of the East2: MAYOR (singing): As mayor of the Munchkin City In the county of the Land of Oz, I welcome you most regally. BARRISTER (singing): …

Previous articleNext article No AccessComment: Will Futility Policies Make a Difference?Robert D. OrrRobert D. OrrFletcher Allen Health Care, Burlington, Vermont Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Volume 11, Number 2Summer 2000 Published on behalf of the MacLean Center for Clinical Medical Ethics Article DOIhttps://doi.org/10.1086/JCE200011207 © 2000 The University of Chicago. All rights reserved.PDF download Crossref reports no articles citing this article.

Previous articleNext article No AccessThe Role of the Clinical Ethicist in Conflict ResolutionRobert D. Orr and Dennis M. deLeonRobert D. OrrLoma Linda University Medical Center; Loma Linda University School of Medicine Search for more articles by this author and Dennis M. deLeonLoma Linda University Medical Center; Loma Linda University School of Medicine Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Volume 11, Number 1Spring 2000 Published on behalf of the MacLean Center for Clinical Medical Ethics Article DOIhttps://doi.org/10.1086/JCE200011103 Views: 6Total views on this site © 2000 The University of Chicago. All rights reserved.PDF download Crossref reports no articles citing this article.

Previous articleNext article No AccessShould Children with Severe Cognitive Impairment Receive Solid Organ Transplants?Robert D. Orr, Joyce K. Johnston, Stephen Ashwal, and Leonard L. BaileyRobert D. OrrLoma Linda University Medical Center; Loma Linda University Children's Hospital Search for more articles by this author , Joyce K. JohnstonLoma Linda University Children's Hospital Search for more articles by this author , Stephen AshwalLoma Linda University Children's Hospital Search for more articles by this author , and Leonard L. BaileyLoma Linda University Medical Center; Loma Linda University Children's Hospital Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Volume 11, Number 3Fall 2000 Published on behalf of the MacLean Center for Clinical Medical Ethics Article DOIhttps://doi.org/10.1086/JCE200011304 © 2000 The University of Chicago. All rights reserved.PDF download Crossref reports no articles citing this article.

Although heart transplantation has become recognized as a viable option for the treatment of incorrectable heart disease in infants and children, its application becomes less clear in infants with potentially serious neurologic impairment. The following case study illustrates one transplant team's approach to decision making in the case of an infant born with a chromosomal deletion syndrome.

Savulescu maintains that our paper, which encourages clinicians to honour requests for "inappropriate treatment" is prejudicial to his atheistic beliefs, and therefore wrong. In this paper we clarify and expand on our ideas, and respond to his assertion that medicine, ethics and atheism are objective, rational and true, while religion is irrational and false.

Oscar Thompson, a third-year medical student on a shift in the emergency department, is eager to participate in as many procedures as possible. According to the triage nurse’s history, the next patient to be seen is a 58-year-old man who has had fever, headache, and neck stiffness. Anticipating his first lumbar puncture, Oscar approaches the room with enthusiasm. The nurse whispers that the patient is irritated and can’t wait to see the doctor. The student pauses, draws back the curtain, and says, “Hello, I’m Dr. Thompson, how can I help you today?”

Public and professional discussions have recently raised the question of whether the long-standing proscription against physician-assisted suicide for terminally ill patients should be eliminated or changed. In this article we first review the history of the centuries-long debate, and repeat the arguments stated for and against such a change. We present our opposition to such a change based on the adverse consequences which would occur in the patient-doctor relationship, and the very likely extension of the practice from only terminally ill patients to some who are suffering but not dying, including patients with intractable mental suffering. We review the 10-year social experiment with public toleration of euthanasia in the Netherlands, and note its considerable expansion beyond the clear guidelines. We then discuss why we believe psychiatrists should continue to oppose the legalization of physician-assisted suicide. In addition to our concern about the extension to assisted-suicide for mental suffering, we point out the adverse affect such changes would have on both the psychiatrist's and the patient's perception of the role of the therapist in other suicide situations, and the difficulty of uncovering a competent patient's motivation for a request for such assistance.

Previous articleNext article No AccessUse of the Hippocratic Oath: A Review of Twentieth Century Practice and a Content Analysis of Oaths Administered in Medical Schools in the U.S. and Canada in 1993Robert D. Orr, Norman Pang, Edmund D. Pellegrino, and Mark SieglerRobert D. OrrLoma Linda University School of Medicine Search for more articles by this author , Norman PangLoma Linda Medical Center Search for more articles by this author , Edmund D. PellegrinoGeorgetown University Search for more articles by this author , and Mark SieglerUniversity of Chicago Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Volume 8, Number 4Winter 1997 Published on behalf of the MacLean Center for Clinical Medical Ethics Article DOIhttps://doi.org/10.1086/JCE199708409 Views: 5Total views on this site Citations: 2Citations are reported from Crossref © 1997 The University of Chicago. All rights reserved.PDF download Crossref reports the following articles citing this article: Robert M. Veatch and Cheryl C. Macpherson Medical School Oath-Taking: The Moral Controversy, The Journal of Clinical Ethics 21, no.44 (Dec 2022): 335–345.https://doi.org/10.1086/JCE201021409 by Paul J. Weithman Of Assisted Suicide and “The Philosophers' Brief” Weithman, Ethics 109, no.33 (Jul 2015): 548–578.https://doi.org/10.1086/233921

Interest in the retrieval of organs from non-heart-beating cadaver donors has been rekindled by the success of transplantation of solid organs and the insufficient supply of donor organs currently obtained from heart-beating cadaver donors. There are currently two retrieval techniques being evaluated, the in situ cold perfusion approach and the controlled death approach. Both, however, raise ethical concerns. Reanimation is a new method which has been used successfully in animals. We believe this new approach overcomes the ethical objections raised to these other methods.

Requests by patients or their families for treatment which the patient's physician considers to be ''inappropriate'' are becoming more frequent than refusals of treatment which the physician considers appropriate. Such requests are often based on the patient's religious beliefs about the attributes of God (sovereignty, omnipotence), the attributes of persons (sanctity of life), or the individual's personal relationship with God (communication, commands, etc).We present four such cases and discuss some of the basic religious tenets of the three Abrahamic faith traditions as they relate to such requests. We suggest that religious reasons for requesting ''inappropriate'' treatment are ''special'' and deserve serious consideration.We offer guidance to assist clinicians and clinical ethicists as they attempt to resolve these conflicts, emphasising the importance of understanding the religious beliefs of the patient/surrogate and suggesting the assistance of a religious interpreter. We suggest open discussion with patients and families of both the clinical situation and the theological basis for these requests. We also suggest that clinicians use additional religious doctrines or principles from patients' own traditions to balance the reasons behind the requests.We conclude that most persistent requests for ''inappropriate'' treatment should be honoured.

Federal regulations governing pharmacologic research require scientific proof of efficacy. Although these regulations are often interpreted to mean that a placebo-controlled trial is necessary, it is difficult to justify use of placebo controls when effective standard therapy exists. Justification is especially problematic in psychopharmacologic research because of the added concern that subjects with compromised decision-making capacity cannot give valid consent. To promote discussion and consensus, this article presents guidelines for the ethically justifiable use of placebo controls in research with psychopharmacologic agents. The guidelines, developed by a university's institutional review board, are designed to help investigators design studies and to protect vulnerable subjects.