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.