Wednesday, July 20, 2016

Is assisted dying the baby boomers’ last frontier?


It is truly remarkable how radically Western societies were remade by the baby boomer generation. They campaigned for the decriminalisation of abortion and succeeded in most liberal democracies. As Carole Levine rightly notes, ‘the women’s movement of the 1960s and 1970s was a frontline attack on (the) patriarchal and authoritarian model’ of decision-making in the medical profession.[1] Baby boomers also campaigned for the decriminalisation of same sex acts and eventually brought us marriage equality, even in a country as conservative as the United States. They campaigned for the decriminalisation of (soft) drugs and we are beginning to see increasing numbers of jurisdictions dabbling in the decriminalisation of at least cannabis. This, of course, is also partly due to the failure of the war against drugs. Restrictive drug legislation is reportedly responsible for about 5 billion people’s lack of end-of-life access to opioids across the globe.[2]

With baby boomers being anywhere between 52 and 70 years of age, invariably the end of life is coming into focus for an increasing number of people belonging to this generation. They would have seen parents and relatives suffering often terribly at the hands of a medical system that ignored their end-of-life choices in favour of life support at nearly all cost. Even today about 35% of patients who are at the end of the life receive non-beneficial medical care, including care that will result in a deterioration of their quality of life, such as, for instance, radiotherapy and dialysis.[3] Bioethicists have long proposed a patient focused approach to these kinds of challenges. Robert Veatch, for instance, noted that ‘the arrogance of the medical professional claiming that he or she (mostly ‘he’) had the authority to decide, even against a patient’s wishes, what was best for the patient was morally indefensible. Physicians were deciding not only that continued torturous life-support was in a dying person’s best interest, but that the physician’s ‘order’ justified continued infliction of that torture.  That ethic seemed so wrong, so contrary to any moral decency, that it was only natural to challenge it in the name of patient rights.’[4]

It is not terribly surprising, with baby boomer finding themselves – perhaps to their greatest surprise - at the levers of power of the system that they rebelled against in the 1960s and 1970s, that the number of jurisdictions that have decriminalised assisted dying is steadily increasing. Many legislators and judges are baby boomers. Just like baby boomers fought hard for the right to live their life by their own lights, they were bound not to hand control over to others when it came to their own dying. Their own foreseeable demise has clearly focused minds in many a jurisdiction and highest court room. The debates about supposedly significant moral distinctions between active forms of assisted dying and letting die – never an ethically plausible distinction to begin with - seem to have quietly faded away in favour of respect for considered patient choice. Today’s debates focus on the potential for abuse affecting disabled people and vague others labelled ‘vulnerable’ by those campaigning against medical aid in dying. Where you stand on these questions is not that significant as they will be settled by empirical evidence that is accumulating rapidly in the increasing number of jurisdictions that are decriminalising medical aid in dying in different forms and shapes. As I write this the Canadian parliament voted in favor of legislation that would make euthanasia and assisted suicide available to competent terminally ill patients. The availability of legal access to euthanasia is a first in North America. The state of California passed assisted suicide legislation a few months ago. It came into effect in June 2016. Access to assisted suicide in California is limited to terminally ill patients. Similar efforts are underway in a number of other states in the USA. France decided, also in 2016, to introduce a terminal sedation regime for eligible patients. Step by step baby boomers successfully wrestle(d) away control over our dying from the medical profession and restrictive legislation.

The next frontier for our baby boomer legislators and judges, undoubtedly, will be the issue of scope, when it comes to assisted dying. Should it be patient choice, irreversibility of the disease condition and unbearable quality of life as decision-making criteria, or should impending death be added as another necessary condition. The former arguably gels with the ‘my life, my body, my choice’ attitude that drove most of the political campaigns that led to the societal changes mentioned earlier. Historians of bioethics will hopefully keep a watchful eye on these developments.



[1] C. Levine. Analyzing Pandora’s Box: The History of Bioethics. In: L.A. Eckenwiler, F.G. Cohn. 2007. The Ethics of Bioethics: Mapping the Moral Landscape. Johns Hopkins University Press: Baltimore, p. 7.
[2] Economist Intelligence Unit. 2010. The quality of death: Ranking end-of-life care across the globe. London. http://graphics.eiu.com/upload/eb/qualityofdeath.pdf [Accessed 27 June 2016]
[3] M. Cardona-Morrell, J.C.H. Kim, R.M. Turner, M. Anstey, I.A. Mitchell, K. Hillman. Non-beneficial treatments in hospital at the end of life: a systematic review on extent of the problem. International Journal for Quality in Health Care 2016, 1–14 doi: 10.1093/intqhc/mzw060.
[4] R. Veatch. The Birth of Bioethics: Autobiographical Reflections of a Patient Person. Cambridge Quarterly of Healthcare Ethics 2002; 11: 344-352.

Monday, July 18, 2016

2016 Google Scholar Metrics for Bioethics journals

I'm afraid the list isn't quite complete as for some reason at least one well-known quality publication, the Kennedy Institute of Ethics Journal, just doesn't pop up. It's also the case that some journals that were covered in the past have disappeared from google's radar, even though they continue to exist. This info from google's media release might explain the inclusion and exclusion of particular journals: 'Publications with fewer than 100 articles in 2011-2015, or publications that received no citations over these years are not included.'



Quite possibly the below table will be displayed in odd ways on your screen, mea culpa. 

Usual CoI blurb applies. I co-edit two of the journals in this list. List up-dated July 2016.



*h5-index is the h-index for articles published in the last 5 complete years. It is the largest number h such that h articles published in 2010-2014 have at least h citations each


**h5-median for a publication is the median number of citations for the articles that make up its h5-index

                                                                                                    H5 index   H5 median

Journal of Medical Ethics                                                             29           42

Nursing Ethics                                                                              29           36

Science and Engineering Ethics                                                 26             36

The American Journal of Bioethics                                              26           36

Journal of Law, Medicine and Ethics                                           26           34

Neuroethics                                                                                   24           30

Bioethics                                                                                       22           31

Ethics                                                                                           20            35

bmc medical ethics                                                                       20           29

Hastings Center Report                                                                 19           29

American Journal of Bioethics Neuroscience                            19             28

Medicine, Health Care and Philosophy                                       17            22

Journal of Empirical Research on Human Research Ethics         16           18

Journal of Medicine and Philosophy                                            15           25

Nursing Philosophy                                                                        15          23

Perspectives in Biology and Medicine                                           13          15

Public Health Ethics                                                                       14           27

Developing World Bioethics                                                         14           20

Health Care Analysis                                                                     14          19

Journal of Bioethical Inquiry                                                           14           18

Theoretical Medicine and Bioethics                                               14           17

HEC Forum                                                                                     13           26

Cambridge Quarterly of Healthcare Ethics                                     13           20

The Journal of Clinical Ethics                                                        13           18

NanoEthics                                                                                     11           16

Indian Journal of Medical Ethics                                                     10           12

Asian Bioethics Review                                                                   8              18

International Journal of Feminist Approaches to Bioethics              8             15

Narrative Inquiry in Bioethics                                                           8              13

South African Journal of Bioethics and Law                                     8             10

Ethik in der Medizin                                                                         7              12

Clinical Ethics                                                                                   7            8  

Christian Bioethics                                                                            5              10

Yale Journal of Health Policy, Law, and Ethics                                5             8

Monash Bioethics Review                                                                 5              6

Journal international de bioethique                                                    4              7

National Catholic Bioethics Quarterly                                              4              4