I am inclined to agree with Arthur Caplan that a less invasive means than was employed in the case of Ashley X would have been preferable. But, such means do not, as yet, exist. Given these circumstances, what are the issues that the bioethics committee needs to consider prior to making a recommendation to the surgeon?

The ethics committee met and discussed the case with the surgeon. Just prior to this, the bioethics committee at a nearby medical center received a referral for a similar case. That committee had already undertaken a thorough review of the literature and the legal proceedings involved in the Seattle Ashley case. The medical center committee agreed to share their findings and deliberations with the children’s hospital committee and sent two representatives (both attorneys) to present their information. In addition, members of the children’s hospital committee had a conference call with the pediatric endocrinologist who had been involved with the case at the medical center.

Approximately one in three American adults has executed a living will or healthcare declaration stating personal preferences regarding medical treatment in the event that he or she becomes terminally ill and unable to communicate. This figure stands in striking contrast to the 90% of Americans who, when asked, express specific wishes regarding their choice of care under such circumstances. Congress attempted to increase the number of Americans with advance directives when it passed the Patient Self Determination Act in 1990, billed at the time as the “Miranda Warning” of medicine, which requires hospitals and nursing homes receiving federal funds both to inform patients of their right to refuse life-sustaining care and to record all written directive in patients’ charts.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to feature editors Kenneth V. Iserson and Barry Morenz at [email protected].