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Driving with Cognitive Impairment
Author(s) -
Barr Robin,
Foley Daniel
Publication year - 1993
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1993.tb06199.x
Subject(s) - medicine , crash , cognitive impairment , motor vehicle crash , injury prevention , occupational safety and health , poison control , demography , human factors and ergonomics , cognition , gerontology , environmental health , psychiatry , pathology , sociology , computer science , programming language
cation in the title of their piece, that they concede that physician-assisted suicide can be cogently distinguished from voluntary active euthanasia. But in their efforts to demonstrate how physician-assisted suicide and voluntary active euthanasia have some features in common, they conclude with what, to us, is an unwarranted dichotomy: "All forms of assisted suicide and voluntary euthanasia stand on one side of the contrast, with involuntary and non-voluntary euthanasia on the other side." Their agenda appears to be to assure that, if a consensus on ethical guidelines regarding assisted suicide and euthanasia is established, voluntary active euthanasia ought not be proscribed along with nonvoluntary euthanasia as indefensible options. We agree that a key issue in this debate is patient autonomy, but would argue that autonomy is not an all-or-nothing phenomenon. Instead, it is our clinical experience that patient autonomy involves a continuum, based not only on whether patients ultimately retain a final choice, whatever the issue, but also on their ability to exercise that choice by acting on it. From this perspective, physician-assisted suicide enables patients to make choices and then act on them independently. With physician-supervised suicide, while patients may make the choices, they are only partly able to exercise those choices and rely on others to help implement them. To the extent that they are dependent on the physician to participate actively in their suicide, they become more vulnerable to external interference. In voluntary active euthanasia, while patients may make the choice not to live any longer, they do not exercise that choice, but depend entirely on others to carry out their wishes. Our argument on this point, then, is that, to the extent that such patients are more dependent on others to carry out the choices they have made, they become more vulnerable to potentially adverse influences. Hence, to us, physicianassisted suicide maximizes patient autonomy and is the easiest to assure safeguards.