Matters of Life and Death

Book excerpt: Orentlicher uses controversial life-and-death issues as case studies for evaluating three models for translating principle into practice. Physician-assisted suicide illustrates the application of "generally valid rules," a model that provides predictability and simplicity and, more importantly, avoids the personal biases that influence case-by-case judgments. The author then takes up the debate over forcing pregnant women to accept treatments to save their fetuses. He uses this issue to weigh the "avoidance of perverse incentives," an approach to translation that follows principles hesitantly for fear of generating unintended results. And third, Orentlicher considers the denial of life-sustaining treatment on grounds of medical futility in his evaluation of the "tragic choices" model, which hides difficult life-and-death choices in order to prevent paralyzing social conflict.