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April 22/29, 1998

Deciding Life and Death in the Courtroom: Debate and Clarification

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(16):1259-1261. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-16-jac80007

To the Editor.—It is easier to find dogmatic statements than guiding principles in the assisted-suicide debate. I am inclined to rely on my intuition in such situations, and work backward to a principle. I do not wish to belittle the need for legal definitions. In fact, these often clarify precedent and serve to make us all pause where we once felt so certain.

But, I must place the legal system in perspective in this debate. Mr Gostin's article1states, "The judiciary has transformed not only the practice of medicine and the rights of patients, but has also shaped societal values." Rights are inherent and need to be defined. The judiciary cannot and should not try to transform them. The judiciary also cannot shape societal values. It has a duty to reflect societal values (common law?). On the issue in question, however, this inflated view of "judiciary impact" fails to acknowledge that the overwhelming majority of "end-of-life" decisions are comfortably and quietly carried out between patients and their physicians. This compelling empirical observation should guide us to seek the truth in these decisions, rather than assume that they must be occurring unethically without the watchful eye of the judiciary.