In this article (the first of a two-part interview), Linda L.
Emanuel, MD, PhD, discusses bioethics. Part I highlights end-of-life care and
physician-assisted suicide, while part II, which will appear in an upcoming
issue of ONI, focuses on organizational ethics and future issues in bioethics.
Dr. Emanuel is Buehler Professor of Aging and director of the Buehler Center
on Aging, Northwestern University Medical School. She was formerly vice
president for ethics standards at the American Medical Association (AMA).
Dr. Emanuel has written and lectured widely on bioethics, including editing
the book Regulating How We Die: The Ethical, Medical, and Legal Issues
Surrounding Physician-Assisted Suicide (Harvard University Press, 1998).
Oncology News International: How did you first become interested in bioethics?
Dr. Emanuel: For me, the precipitating events were around end-of-life care.
I was right out of medical school, in training. The specific case that
triggered my interest was a 64-year-old woman with pneumonia who came into the
emergency ward in respiratory arrest. We resuscitated her successfully only to
find that she was left in a vegetative state.
ONI: Advance directives are an important part of end-of-life care. How can
they be implemented on a practical level?
Dr. Emanuel: Advance directives have been implemented in a spotty kind of
way. Something upward of 25% of patients have advance directives of some kind,
whether it is a short conversation with a member of the family or a formal
written and filed document. That figure is from 5 or 6 years ago, but it is
probably still a relatively small number. A benchmark is that 50% of patients
have estate planning on record, so I think we have a way to go.