Arthur Isak Applbaum

A Family's Request for Complementary Medicine After Patient Brain Death

A 19-year-old woman living with relatives in the United States who was admitted for elective cranial surgery for complications related to a congenital disorder developed an acute intracranial hemorrhage 10 days after surgery. The patient was declared dead following repeat negative apnea tests. The patients father requested that the treating team administer an unverified traditional medicinal substance to the patient. Because of the unusual nature of this request, the treating team called an ethics consultation. The present article reviews this case and discusses other cases that share key features to determine whether and when it is appropriate to accommodate requests for interventions on patients who have been declared dead.

PROFESSIONAL DETACHMENT: THE EXECUTIONER OF PARIS

Saviours of the homeland, hereafter do not make such a hasty end of criminals who fall into your clutches. Put it to those extreme patriots of excess that it is no service to their fellow citizens to eradicate, by their slapdash zeal, the only way to come at the root of the catastrophes that were then being prepared. Put it to them that they owe me compensation for the executions of which they have deprived me. Each of the heads of the four scoundrels, if my sword had put them off their shoulders, would have been worth twenty ecus to me. Put it to them that the work would have been much more neatly done and that a great many spectators would have enjoyed the spectacle of the sacrifice of these vile victims, if the tragedy had been played at my theatre.

The Idea of Legitimate Authority in the Practice of Medicine

Legitimate authority is the normative power to govern, where a normative power is the ability to change the normative situation of others. Correlatively, when one has the normative power to govern others, these others face a normative liability to be governed. So understood, physicians do not have legitimate authority over their patients, and patients do not have legitimate authority over their physicians. An authority is legitimate only when it is a free group agent constituted by its free members. On this conception, associations of physicians sometimes have legitimate authority over individual physicians, and physicians sometimes count as members subject to the legitimate authority of these associations. This might be so even when they have not consented to membership.