E. Howe

In this issue of The Journal of Clinical Ethics, Emily Bell and Eric Racine are guest editors of a special section focusing on the use of deep brain stimulation (DBS) to treat Parkinson’s disease. In “Deep Brain Stimulation, Ethics, and Society,” Bell and Racine report that DBS already has been used to treat more than 50,000 patients. The ethical issues raised in this special section are important not only in regard to Parkinson’s disease and DBS, but in many areas of medicine.The articles discuss sound, state-of-the-art ethical approaches. This introduction to the issue presents approaches that are adjunctive and intended to increase careproviders’ options, that should increase careproviders’ ability to individualize the care that they provide to their patients.

This article reviews careproviders’ most difficult emotional challenges during disasters and provides approaches for responding optimally to them. It describes key approaches that careproviders may pursue to best help patients and others during a catastrophe. It raises unanswered questions regarding when, if ever, careproviders should provide active euthanasia to patients who are incompetent, and when, if ever, careproviders should give their own food and water to patients or others who may otherwise soon die without them.

This article discusses a case in this issue of The Journal of Clinical Ethics by McCrary and colleagues, “Elective Delivery Before 39 Weeks’ Gestation Reconciling Maternal, Fetal, and Family Circumstances,” in which parents asked the medical team to deliver their fetus “early.” The author discusses (1) the importance that parents have to a child when they are able to love the child, and how important it is for decision makers to consider this; (2) exceptional approaches that may enable parents to “change their minds”; and (3) substantive and procedural innovations that may help to prevent clinicians’ views from playing too big a role and/or being arbitrary. The author concludes by describing how he felt when reading the case and uses this to illustrate how clinicians may benefit by assessing their feelings.