Is there a lingua franca for bioethics at the end of life?

Death with "dignity": the wedge that divides the disability rights movement from the right to die movement

Much of the American debate over physician assisted death (PAD) is framed as an ideological split between conservatives and liberals, pro life and pro choice advocates, and those who emphasize morality versus personal autonomy. Less examined, but no less relevant, is a split within the ranks of progressives--one that divides those supporting a right to die in the name of human rights from disability rights activists who invoke human rights to vehemently oppose euthanasia. This paper reviews how "dignity" serves both as a divisive wedge in this debate but also as a value that can span the divide between groups and open the way to productive discourse. Supporters of legalized euthanasia use "dignity" to express their position that some deaths might indeed be accelerated. At the same time, opponents adopt the concept to argue that physician assisted suicide stigmatizes life with a disability. To bridge this divide, the worldviews of two groups, Compassion & Choices and Not Dead Yet, are studied. The analysis concludes that the two organizations are more parallel than contrary--a finding that offers opportunities for dialogue and perhaps even advances in public policy.

Limitation of Treatment at the End-of-Life: Withholding and Withdrawal

Most deaths in the United States occur under the care of a physician. In most of these cases, decisions must be made about whether to initiate and continue or withdraw life-sustaining medical technology, such as cardiopulmonary resuscitation, ventilation, nutrition and hydration, dialysis, transfusions, and antibiotics. All are part of a medical technological armamentarium that should be used when the goal of treatment is a cure. When a cure is not possible or appropriate, these medical technologies should be withdrawn or withheld. The circumstances in which end of life treatment may be ethically and legally limited through withholding or withdrawal are discussed.

Communicating with surrogate decision-makers in end-of-life situations: substitutive descriptive language for the healthcare provider

This article discusses the manner and actual wording used by healthcare providers in communicating difficult information as it relates to end-of-life discussions. Several examples are given and substitutive language is suggested for more effectively obtaining informed consent from surrogate decision-makers, who are often responsible for determining the course of care for the terminally ill.