Medical Torture: End of Life Decision-Making in the United Kingdom and United States
![handle is hein.journals/cjic14 and id is 517 raw text is: MEDICAL TORTURE: END OF LIFE
DECISION-MAKING IN THE UNITED
KINGDOM AND UNITED STATES
Jon D. Feldhammer*
- Now death is not the worst that can happen to men....
MR. SMITH IS A 54-year-old man with non-small-cell lung can-
cer [in his oncologists' office] following restaging evaluation af-
ter his latest round of chemotherapy. He is now on his third
different chemotherapy regimen after two brief partial remis-
sions followed by the inevitable progressions. His performance
status is declining as the toxicities of chemotherapy mount. The
[tests] show that once again his liver metastases have grown.
After he is told this news, he is not surprised. When he is told
his likelihood of responding to yet another chemotherapy regi-
men are slim, he replies, But doctor, what have I got to lose?2
Mr. Smith is going to die of cancer;3 how he dies will depend
on the treatment he chooses. There are two treatment options
available; one of aggressive life-prolonging therapy, the other palli-
ative pain treatment. If Mr. Smith chooses aggressive treatment,
he will continue to undergo chemotherapy that will cause vomiting,
diarrhea, loss of hair, and permanent hospitalization. His liver will
stop working and he will suffer dementia,4 jaundice,5 kidney fail-
ure, a diminished immune system, rapid gastrointestinal bleeding,6
* Editor in Chief, Cardozo Journal of International & Comparative Law. Candidate
for Juris Doctorate, Benjamin N. Cardozo School of Law, June 2007. I would like to thank
my wife, Rachel Kuperman, M.D. for all her help and support.
1 PLATO, LAWS, BOOK IX, available at http://www.gutenberg.org/dirs/etext99/
plawsll.txt
2 Paul R. Harnett & Timothy J. Moynihan, But Doctor, What Have I Got to Lose...?,
19 J. CLINICAL ONCOLOGV 3294, 3294 (2001).
3 Id. (citing statistics that indicate the odds of any drugs shrinking the cancer are less
than 5 percent and even if the cancer does shrink, there is no evidence that the treatment
will allow Mr. Smith to live any longer; and there is a 90 percent chance of further treat-
ment making Mr. Smith sick enough to require hospitalization).
4 This is known as hepatic encephalopathy, a condition usually occurring secondarily
to advanced liver disease, marked by disturbances of consciousness that may progress to
deep coma, psychiatric changes of varying degree, flapping tremor, and fetor hepaticus.
DORLAND'S POCKET MEDICAL DICTIONARY 283 (25th ed. 1995).
5 Jaundice will make Mr. Smith's skin turn yellow and itch. This is caused by a build-
up of the body's natural toxins that the dying liver can no longer process.
6 This condition is life threatening and will cause his stomach to become extremely
distended and bloated.](ViewImageLocal?handle=hein.journals/cjic14&div=20&collection=journals&method=preview&ext=.png&size=3)
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Medical Torture: End of Life Decision-Making in the United Kingdom and United States
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