Many advances in public health and medical technology have contributed to the improved wellbeing and overall longevity of Americans. Such benefits, however, have been offset by a change in the nature and prolongation of the dying process. Daniel Callahan offers a challenge to caregivers in his observation of violent death by technological attenuation, and he sets an agenda to identify a more appropriate approach to the needs of the dying.

Over the past quarter century, hospice has increasingly been used as a resource for care at the end of life. However, according to 1995 estimates by the National Hospice Organization (NHO), hospice care presently accounts for only about 15 percent of the care of terminally ill patients in the United States. We will review issues of access and use of hospice services and examine the various institutional, professional, societal, and cultural barriers to hospice principles of care, and consider various options to promote optimal care at the end of life.

On July 3, 1996, in Jones v. United States(No. 93-20137, 1996 U.S. Dist. WL 382937 (N.D. Cal. July 3,1996)), the United States District Court for the Northern District of California held that plaintiffs in a wrongful birth action cannot recover costs or damages associated with the birth and upbringing of their daughter absent evidence of causation and proof to satisfy liability requirements. Plaintiffs scientific evidence regarding the alleged interaction between antibiotics and oral contraceptives did not satisfy the Daubertstandard (Daubert v. Merrell Dow Pharmaceuticals, Inc.,509 US. 579, 597 (1993) (remanded, Daubert v. Merrell Dow Pharmaceuticals, lnc.,43 F.3d 1311, 1315 (9th Cir.), cert. denied,116 S. Ct. 189 (1995))) for admissibility developed by the Supreme Court. In addition, the plaintiffs failed to meet their burden of persuasion on duty of care and causation.

On January 16, 1992, Karyn Jones went to a U.S. Army gynecologist, Dr. James Murphy, to obtain a prescription for birth control pills.

We have always had the ability to commit suicide or request euthanasia in times of serious illness. Yet these acts have been prohibited by the Christian tradition from early times. Some Christians, as they see relatives and friends kept alive too long and in poor condition through the use of current medical powers, however, are beginning to question that tradition. Are assisted suicide and euthanasia compassionate Christian responses to those in pain and suffering who face death? Or are they ways of isolating and abandoning them, of fleeing from Christian compassion, rather than expressing it?

The Committee on Medical Ethics of the Episcopal Diocese of Washington recently issued a report addressing assisted suicide and euthanasia. These matters cry out for religious contributions and perspectives, the Committee believes. The group recognizes that religious voices should not determine public policy, but believes they should be heard as we develop a social consensus about assisted suicide and euthanasia.

In the summer of 1979, a group of experts on law, medicine, and ethics assembled in Siracusa, Sicily, under the auspices of the International Commission of Jurists and the International Institute of Higher Studies in Criminal Science, to draft guidelines on the rights of persons with mental illness. Sitting across the table from me was a quiet, proud man of distinctive intelligence, William J. Curran, Frances Glessner Lee Professor of Legal Medicine at Harvard University. Professor Curran was one of the principal drafters of those guidelines. Many years later in 1991, after several subsequent re-drafts by United Nations (U.N.) Rapporteur Erica-Irene Daes, the text was adopted by the U.N. General Assembly as the Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care. This was the kind of remarkable achievement in the field of law and medicine that Professor Curran repeated throughout his distinguished career.

The Court of Appeals of Minnesota, in State v. Saunders (No. C9-95-907, 1996 Mnn. App. LEXIS 60 (Jan. 16, 1996)), held that the statutory offense of practicing medicine without a license was not unconstitutionally vague as applied to a claim involving a farmer who offered a home remedy to cure cancer. The court held that, although Minnesota Statute § 147.081 subd. 3(3) (1994) contains general language and undefined terms, the statute contains sufficient particularity to show ordinary persons what conduct is prohibited, and thereby passes the void-for-vagueness test. The court stated that, according to the statute, while a person holding a license to practice medicine is permitted to engage in a broad range of conduct, those without that license are proscribed from engaging in that same range of conduct.

The defendant, Mr. Saunders, a dairy farmer, claimed that he could cure ill people by injecting an ill person's blood into a cow and then feeding that person the cow's colostrum.