[Does the written press give a fair account of a complex medical question: «the Vincent Lambert case¼?] / La presse écrite rend-elle compte d'une façon juste d'une question médicale complexe : « le cas Vincent Lambert ¼ ?

Does the written press give a fair account of a complex medical question: "The Vincent Lambert Case"? We have studid press articles referring to Mr. Vincent Lambert's situation from 2013 to 2017. Analysis using a reading grid (including 7 questions) of press articles from four French daily newspapers (Libération, Le Monde, Le Figaro and La Croix) and a specialized medical news site (Agence de presse médicale) so that they can build their own opinion. 341 articles were analyzed (61 articles from Libération, 65 articles from Le Monde, 86 articles from Le Figaro, 82 articles from La Croix, 47 articles from the APM), writing a chronology of the main facts of the patient's history from 2013 to 2017 in order to have benchmarks to estimate the accuracy of the information reported in the various articles. Articles are rarely fully explicit. Inadequate expressions ("passive euthanasia", "end-of-life procedure") are used in the majority of newspapers. Some articles present the facts in a partisan way and contribute to mask the complexity of the patient's situation. Court decisions are often shortened and therefore simplified, which does not help the reader to understand the situation in an informed way. Reflective benchmarks are sometimes found in the various newspapers from 2013 to 2016. From 2016 onwards, we notice that the articles are shorter and that they no longer give any reference points for reflection. The daily written press in its current format does not seem to be able to help the general public to obtain accurate information on complex issues involving broad areas of reflection. The difficulty of the journalist's work in addressing this type of questioning comes partly from the constraints of brevity that are often imposed on them on the one hand and from the constant evolution of the information itself on the other.

La presse écrite rend-elle compte d'une façon juste d'une question médicale complexe : « Le Cas Vincent Lambert ¼ ? Nous avons analysé des articles de presse faisant référence à « l'affaire Vincent Lambert ¼ parus de 2013 à 2017 pour comprendre la façon dont la presse quotidienne française grand public relate les questions médicales complexes à forte tonalité éthique et interroger sa capacité à informer avec justesse ses lecteurs pour qu'ils puissent se construire leur propre opinion. À l'aide d'une grille de lecture (comportant 7 questions), 341 articles de presse de 4 quotidiens français (Libération, Le Monde, Le Figaro et La Croix) et d'un site de dépêches médicales spécialisées (Agence de presse médicale) ont été analysés. Les articles apparaissent rarement entièrement explicites. Des expressions inadaptées (« euthanasie passive ¼, « procédure de fin de vie ¼) sont utilisées dans la majorité des journaux. Certains articles exposent les faits de manière partisane et participent à maquiller la complexité de la situation du patient. Les décisions de justice sont souvent raccourcies et donc simplifiées, ce qui n'aide pas le lecteur à saisir la situation de manière éclairée. Des repères réflexifs sont parfois retrouvés dans les différents journaux de 2013 à 2016. À partir de 2016, on remarque que les articles sont plus courts et ne donnent plus aucun repère de réflexion. De nos jours, la presse écrite n'est probablement plus le premier vecteur d'information choisi par le citoyen. Les articles des titres de presse étudiés dans leur format actuel ne sont peut-être pas le meilleur moyen d'aider le grand public à s'informer de manière juste sur des questions complexes englobant de vastes champs de réflexion. La difficulté du travail du journaliste pour aborder ce type de questionnement vient en partie des contraintes de brièveté qui leur sont souvent imposées d'une part, et de l'évolution constante de l'information elle-même d'autre part.

The Briggsian Heresy? Should Previously Expressed Wishes Determine Best Interests in Decisions Relating to Withdrawal of Clinically-Assisted Nutrition and Hydration?

This paper examines the Court of Protection decision in Briggs v Briggs. It considers whether the approach of the Court, which gave effective decisive weight to a patient's previously expressed wishes about whether he should be kept alive in a minimally conscious state, is a proper application of the 'best interests' test under the Mental Capacity Act 2005. It assesses whether the Briggs approach is effectively applying a 'substituted judgement' test and considers the difficulties in ascertaining what a person's actual wishes are.

It is never lawful or ethical to withdraw life-sustaining treatment from patients with prolonged disorders of consciousness.

In English law there is a strong (though rebuttable) presumption that life should be maintained. This article contends that this presumption means that it is always unlawful to withdraw life-sustaining treatment from patients in permanent vegetative state (PVS) and minimally conscious state (MCS), and that the reasons for this being the correct legal analysis mean also that such withdrawal will always be ethically unacceptable. There are two reasons for this conclusion. First, the medical uncertainties inherent in the definition and diagnosis of PVS/MCS are such that, as a matter of medical fact, it can never be established, with the degree of certainty necessary to rebut the presumption, that it is not in the patient's best interest to remain alive. And second (and more controversially and repercussively), that even if permanent unconsciousness can be unequivocally demonstrated, the presumption is not rebutted. This is because there is plainly more to human existence than consciousness (or consciousness the markers of which can ever be demonstrated by medical investigations). It can never be said that the identity of the patient whose best interests are at stake evaporates (so eliminating the legal or ethical subject) when that person ceases to be conscious. Nor can it be said that the best interests of an unconscious person do not mandate continued biological existence. We simply cannot know. That uncertainty is legally conclusive, and (subject to resource allocation questions and views about the relevance of family wishes and the previously expressed wishes of the patient) should be ethically conclusive.

Advance Directives and Alzheimer's Disease.

Americans who are afraid of living for many years with Alzheimer's might seek a way to end their lives early, when their dementia has just entered the moderate phase. There is no legal process for doing so. In this paper I argue that advance directives, in particular, are not a legal solution for those who prefer to die rather than suffer years of dementia. The problem is that an advance directive only works to hasten death when there is a life-threatening illness for which one can refuse treatment; more often than not, Alzheimer's kills the self long before it kills the body.

The Supreme Court of India on euthanasia: Too little, too late.

On Friday, March 9, 2018 the five-judge Constitution Bench (CB) of the Supreme Court of India (SCI) chaired by Dipak Misra, the Chief Justice of India, pronounced its judgment (1) (henceforth CC judgment) granting, for the first time in India, legal recognition to "advanced medical directives" or "living wills", ie, a person's decision communicated in advance on withdrawal of life-saving treatment under certain conditions, which should be respected by the treating doctor/s and the hospital. It also reiterates the legal recognition of the right to "passive euthanasia"; and draws upon Article 21 - the right to life - of the Constitution of India (henceforth Constitution) (2) interpreting robustly that the "right to life" includes the "right to die with dignity". Justices Misra and Khanwilkar disposed of the writ petition filed in 2005 by Common Cause (3) (henceforth CC petition) saying, "The directive and guidelines shall remain in force till the Parliament brings a legislation in the field" (1:p 192).

New developments in India concerning the policy of passive euthanasia.

Euthanasia and assisted dying are illegal in India according to Sections 306 and 309 of the Indian Penal Code (IPC), and Article 21 of the Constitution of India. There have been a number of cases where the Indian High Courts and Indian Supreme Court issued differing verdicts concerning the right to life and the right to die. Nevertheless, on 7 March 2011, a paradigm shift happened as a result of the Indian Supreme Court's judgment on involuntary passive euthanasia in the case of Aruna Shanbaug. In its judgment, the Supreme Court requested the government to prepare a law on euthanasia. Accordingly, the 241st Report of the Law Commission of India proposed a bill to permit passive euthanasia. In May 2016 the Ministry of Health and Family Welfare (MOHFW) issued the draft bill for public comment in order to create an informed decision. The Indian people are divided on the issue of euthanasia. The majority of the scientific community welcome it, while some religious groups oppose it. Hindus, in general, express both supporting and opposing views on euthanasia, whereas, Christians and Muslims have hardened their opposition against it. The Supreme Court judgment and the Report of the Law Commission pave the way for the development of new policies pertaining to passive euthanasia by the central government of India. Once such legislation is passed, passive euthanasia may, and probably will, have an enormous impact on the cultural, political, public and medical spheres of India in the near future.

Two kinds of physician-assisted death.

I argue that the concept 'physician-assisted suicide' covers two procedures that should be distinguished: giving someone access to humane means to end his own life, and taking co-responsibility for the safe and effective execution of that plan. In the first section I explain the distinction, in the following sections I show why it is important. To begin with I argue that we should expect the laws that permit these two kinds of 'assistance' to be different in their justificatory structure. Laws that permit giving access only presuppose that the right to self-determination implies a right to suicide, but laws that permit doctors to take co-responsibility may have to appeal to a principle of mercy or beneficence. Actually this difference in justificatory structure can to some extent be found in existing regulatory systems, though far from consistently. Finally I argue that if one recognizes a right to suicide, as Oregon and other American states implicitly do, and as the European Court of Human Rights has recently done explicitly, one is committed to permit the first kind of 'assistance' under some conditions.

The ethics of and the appropriate legislation concerning killing people and letting them die: a response to Merkel.

With regard to ethics and legislation, what is the significant difference between a doctor terminating the life-supporting treatment of a patient in the course of his job and a greedy relative of the patient doing the same thing to inherit his wealth? Merkel offers an interesting and inventive answer to this question in terms of the improper violation of personal boundaries. However, despite Merkel's claim to the contrary, his answer does not directly address the question of the relevant ethical similarities and differences between killing and letting die in general. Furthermore, it does not provide the basis a plausible rationale for legislation concerning killing and letting die. The questions of whether letting someone die is ethically the same as killing someone and whether it should be treated the same way by the criminal law are not the same as or tantamount to the question of whether or not it involves the transgression of another person's boundaries.

Comments on the Lambert case: the rulings of the French Conseil d'État and the European Court of Human Rights.

This study examines the decisions of the French Conseil d'Etat (Supreme Administrative Court) and the European Court of Human Rights in the Lambert case concerning the withdrawal of life-sustaining treatments. After presenting the facts of this case, the main legal question will be analyzed from an ethical and medical standpoint. The decisions of the Conseil d'État and then of the European Court of Human Rights are studied from a comparative legal perspective. This commentary focuses on the autonomous will of an unconscious patient and on the judicial interpretation of the right to life as recognized in article 2 of the European Convention on Human Rights. Furthermore, it medically classifies artificial nutrition and hydration (ANH) as a "treatment" which has ethical and legal implications. While the majority of the bioethical community considers ANH a medical treatment, a minority argues that ANH is basic care. This classification is ambiguous and has conflicting legal interpretations. In the conclusion, the author highlights how a French lawmaker in February 2016, finally clarified the status of ANH as a medical treatment which reconciled the different values at stake.

Eutanasia en Chile: una discusión pendiente / Euthanasia in Chile

Euthanasia is a complex medical procedure. Even though end of life decisions are common situations in health practice, there is a lack of consensus about their terminology. In this manuscript, the main concepts about this issue are defined and delimited; including active and passive euthanasia and limitation of therapeutic effort. Then, a revision is made about the international experience on euthanasia, to then go through the Chile’s history in euthanasia and the population’s opinion. In Chile, euthanasia is an act that has been removed from the social dialogue and legislation. In order to have an open discussion in our population about the issue, the debate has to be opened to the citizens, accompanied by clear medical information about the procedure.

Interpretation: a confounding factor.

With reference to the article "Passive euthanasia in India: a critique", authored by Ms Rohini Shukla and published online on August 5, 2015, I would like to make a few comments and highlight the following points. First, the author notes that Section 309 IPC has been decriminalised. This is not so since there has neither been any amendment to the IPC, nor has any ordinance been passed regarding the matter. Attempting suicide is still an offence in India. Second, the author observes that withholding life support is an act of omission and withdrawing life support is an act of commission and the terms have been used interchangeably by the Hon'ble Court, although there is a subtle difference between the two terms.

Vincent Lambert, Dignity in Dying and the European Court: A Critical Evaluation and the Global Reflections.

In this article I analyse the verdict of the European Court of Human Rights in the Case of Lambert and Others v. France, delivered on 5 June 2015, affirming the Conseil d'État's decision holding that the withdrawal of artificial nutrition and hydration from Vincent Lambert, a French national lying in tetraplegia and persistent vegetative state, was consistent with French domestic law and the European Convention for the Protection of Human Rights and Fundamental Freedoms. In order to make a comparative evaluation I give an account of judicial decisions across the world and find that the European Court's decision is an affirmative pronouncement, in the prevailing milieu of judicial heterogeneity, as it recognizes a person's right to die with dignity in the face of conflicting claims and arguments, by giving supremacy to a person's autonomy and right of self-determination over the deep-rooted religious beliefs and undue paternalistic postures. I conclude that right to die with dignity is a profound area where judge-made law is not the answer. The situation calls for greater consensus and uniformity by evolving suitable legislative strategies.

[Omission and Withdrawal of Vital Care. ¿Killing or Letting Die? An Approach From the Moral and Legal Criteria of Action Tipification]. / Omisión y Suspensión de Cuidados Vitales: ¿Matar o Dejar Morir? Una Aproximación desde los Criterios Morales y Jurídicos de Tipificación de la Acción.

This work aims at two objectives. Firstly, at identifying the basic criterions that underlie the conceptual distinction between letting die, on the one hand, and killing by omitting or withdrawing vital care (VCO), on the other. Secondly, at identifying the reasonableness conditions of public interference on the decision either to reject or to withdraw vital care. Based upon a theory of action inspired in the works of John Finnis, Martin Rhonheimer and Elisabeth Anscombe, it is argued that the moral criteria of typification and individuation of VCO is analogous but not identical to the corresponding legal criteria. Assuming this distinction, I suggest a three steps reasonableness test for public interference on the decision to omit or withdraw vital care.