Interesting New Data on Ethical Safeguards in Psychiatric Research

In December's American Journal of Psychiatry, data are presented that indicate the key safeguards of ethical research – informed consent, alternative decision makers, institutional review boards, data safety monitoring boards, and confidentiality measures- are recognized by both research subjects and researchers as important measures used to protect subjects' rights and well-being. Does a positive recognition of these safeguards by the stakeholders say anything about the effectiveness of the safeguards themselves? -Dominic Sisti

Living Wills Do Not Work

The Hastings Center Report article on living wills' failure has drawn notice pretty much everywhere in the major media. Many others have made similar claims (e.g., here), but this piece is quite good and apparently timely as well.

Living wills have become one of bioethics' most embarrassing failures - an imaginative idea that has the support of the majority of bioethicists despite a total lack of support for their efficacy. From the start it has been clear to at least some of us that these documents just make things more confusing and litigious. An incredibly imaginative experiment, it is time to call living wills just that - an experiment, based on little data and thrust out into the medical community at large on the strength of a few prominent persistent vegetative state cases. Given the coverage of this most recent missive in the debate about how to handle patient wishes at the end of life, it will be interesting to see if hospital ethics committees continue to assert that living wills are a smart thing for patients to have.

It is high time for some legislative retooling of the Patient Self-Determination Act and supporting state legislation. The experiment has failed. Time to pull the plug.