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EDITORIAL

Concerning the Basic Idea that the Wish to End Suffering Legitimates Physician Aid in Dying for Psychiatric Patients
Suzanne van de Vathorst

In 2018, 6126 cases of physician aid in dying (PAD) (4.4% of all deaths) were reported in the Netherlands. Of these 6126 cases, 67 involved patients with a psychiatric disease. Psychiatrists reported 34 of these, general practitioners. The Netherlands has universal health care insurance, and equitable access to good quality health care, including psychiatric care. The Dutch generally trust their d...

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Parity Arguments for ‘Physician Aid-in-Dying’ (PAD) for Psychiatric Disorders: Their Structure and Limits
Marie E. Nicolini, Chris Gastmans & Scott Y. H. Kim

Kious and Battin (K&B) argue that psychiatric PAD (PPAD) should be legal in the US, based on a ‘parity’ argument. This is the most popular approach to argue for PPAD. What K&B add is that since, in their view, the parity argument is valid, there is a dilemma because PPAD conflicts with the practice of involuntary commitment in psychiatry. In this editorial, we sketch out the structure ...

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Medical Aid-in-Dying is an Ethical and Important End-of-Life Care Option
Dan Diaz

My wife, Brittany Maynard, died on November 1, 2014, of a brain tumor, but she used medical aid-in-dying to insure a peaceful death and end the unbearable suffering when no other option would provide relief. After Brittany was diagnosed in January 2014, she endured an eight-hour brain surgery and we researched every treatment option that offered any hope of extending her life. But the brain tumor ...

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The Genetic Revolution Highlights the Importance of Nondiscriminatory and Comprehensive Health Insurance Coverage
Jonathan Gruber

Kenneth Arrow, the economist whose 1963 article established the principles of modern health economics, once posed a parable to show the pernicious role that information can play in insurance markets. Suppose there are two islands, each with one farmer on it. The farmers know that a hurricane is coming that will wipe out one of their islands—but they don’t know which one. In that case, the farm...

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TV Writers and Producers and Ethics: How Can I Help?
Eric Manheimer

The year 2016, with the election of Donald Trump, intensified a sense of urgency in many arenas, including health care. It was clear his administration would usher in assaults on the standards, rules, and ethics that were the glue binding truth and storytelling in every area of society. Several TV medical shows were sunsetting, and two showrunners were interested in acquiring my book 12 Patients:...

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The Moral Choices on CRISPR Babies
Sheldon Krimsky

In late November 2018, Chinese scientist Dr. He Jiankui announced at the Second International Summit on Human Genome Editing in Hong Kong that he had used CRISPR/Cas 9 gene editing on two female embryos that were brought to term through an in vitro fertilization (IVF) pregnancy. The world scientific community was ill-prepared for the announcement since the moral issues surrounding the editing of h...

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Medically Unnecessary Genital Cutting and the Rights of the Child: Moving Toward Consensus
The Brussels Collaboration on Bodily Integrity

What are the ethics of child genital cutting? In a recent issue of the journal, Duivenbode and Padela called for a renewed discussion of this question. Noting that modern health care systems “serve individuals with a wide array of preferences about how their bodies should look and function,” they asked how physicians and policymakers should respond to requests for procedures “that may be roo...

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Target Article

Physician Aid-in-Dying and Suicide Prevention in Psychiatry: A Moral Crisis?
Brent M. Kious & Margaret (Peggy) Battin

Involuntary psychiatric commitment for suicide prevention and physician aid-in-dying (PAD) in terminal illness combine to create a moral dilemma. If PAD in terminal illness is permissible, it should also be permissible for some who suffer from nonterminal psychiatric illness: suffering provides much of the justification for PAD, and the suffering in mental illness can be as severe as in physical i...

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Reweighing the Ethical Tradeoffs in the Involuntary Hospitalization of Suicidal Patients
Adam Borecky, Calvin Thomsen & Alex Dubov

Suicide is the 10th leading cause of death in the United States and the second cause of death among those ages 15–24 years. The current standard of care for suicidality management often involves an involuntary hospitalization deemed necessary by the attending psychiatrist. The purpose of this article is to reexamine the ethical tradeoffs inherent in the current practice of involuntary psychiatri...

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