Some thoughts on the rationality and variety of living wills : Original conception by Luis Kutner and transformation in the USA

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  • リビング・ウイルの合理性と多様性に関する思考 : Luis Kutnerの原義とアメリカにおける変容

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We reconsidered the message of Luis Kutner who first conceived the living will (LW). He advocated LW as follows.: 「When the patient is incompetent, the law assumes a constructive consent for him to be treated. Intentional nonfeasance to cause death is murder. Death due to inaction by the physician's desire not to prolong the patient's suffering is clearly distinguishable from active mercy killing. There is no reason in which active euthanasia with patient's consent is criminal, but inactive euthanasia with patient's consent is not criminal. An individual has the right to refuse treatment, even if such treatment would prolong his life. The physician would then be precluded from treatment, and the patient would be permitted to die by virtue of the physician's inaction. The suggested solution is that the individual, while fully in control of his faculties and his ability to express himself, indicates to what extent he would consent to treatment.」 His LW seems to shorten the life in which the sufferer directs discontinuance of treatment on the basis of the right to self-determination. This is thought to be a voluntary inactive euthanasia. This concept appears different from natural death (dying with dignity) in which life-prolonging procedures are prevented from prolonging the dying process. We studied the transformation of LW and explored questions on the rationality and variety of LWs.

Journal

  • Bioethics

    Bioethics 20 (1), 102-110, 2010

    Japan Association for Bioethics

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