Earlier this year, the Royal College of Physicians in the UK published national guidelines on the management of patients with prolonged disorders of consciousness, updating their 2013 guidance ‘particularly in relation to recent developments in assessment and management and … changes in the law governing … the withdrawal of clinically assisted nutrition and hydration’. The report’s primary focus is on patients who could live for many years with treatment and care. This update, by a neurologist, an imaging neuroscientist, and a lawyer-ethicist, questions the document’s rejection of any significant role for neuroimaging techniques including functional MRI and/or bedside EEG to detect covert consciousness in such patients. We find the reasons for this rejection unconvincing, given (i) the significant advances made in the use of this technology in recent years; and (ii) the wider scope for its use envisaged by the earlier (2018) guidelines issued by the American Academy of Neurology. We suggest that, since around one in five patients diagnosed with prolonged disorders of consciousness are in fact conscious enough to follow commands in a neuroimaging context (i.e. those who are ‘covertly conscious’ or those with ‘cognitive motor dissociation’), and given the clinical, ethical and legal importance of determining whether patients with prolonged disorders of consciousness are legally competent or at least able to express their views and feelings, the guidance from the Royal College of Physicians requires urgent review.

In 1993 The Parliament of the World's Religions produced a declaration known as A Global Ethic which set outfundamental points of agreement on moral issues between the religions of the world. However, the declaration did not deal explicitly with medical ethics. This article examines Buddhist and Christian perspectives on euthanasia andfinds that in spite of their cultural and theological differences both oppose it for broadly similar reasons. Both traditions reject consequentialist patterns ofjustification and espouse a 'sanctity oflife'position which precludes the intentional destruction of human life by act or omission.

Nineteen ninety-six saw the publication of a major Dutch survey into euthanasia in the Netherlands. This paper outlines the main statisticalfindings of this survey and considers whether it shows that voluntary euthanasia is under effective control in the Netherlands. The paper concludes that although there has been some improvement in compliance with procedural requirements, the practice of voluntary euthanasia remains beyond effective control.(7ournal ofMedical Ethics 1999;25:16-21)

No abstract

Ranging from the beginning of the nineteenth century to the 1980s, this book focuses on the evolution of the law and medical practice of abortion in England. Little academic attention has hitherto been given to the development and scope of abortion law in England, the formative influence of the medical profession, and the impact of the law on medical practice. Consequently, Dr Keown considers the performance of abortion by doctors, and the influence the medical profession had on the restriction of the law in the nineteenth century and on its relaxation in the twentieth. The book does not deal directly with the legal status of the unborn child, the rights and duties of its parents and of the doctors involved in the provision of abortion or the question of the desirability of reform. Rather, adopting a socio-legal perspective, it considers what the scope of the prohibition of abortion has been and focuses on aspects of professional influence on the evolution of that prohibition, and of professional practice thereunder.