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security of the person except in accordancewith the principles of fundamental justice;the right not to be subjected to cruel andunusual treatment or punishment; and theright to equal protection and equal benefitof the law without discrimination. :But the court said that while the prohi-

bition deprives Rodriguez "of autonomyover her person and causes her physicalpain and psychological stress... anyresulting deprivation, however, is not con-trary to the principles of fundamental

justice". "Fundamental justice requiredthat a fair balance be struck between theinterests of the state and those of theindividual. The respect for human dignity,while one of the underlying principles uponwhich our society is based, is not a principleof fundamental justice" under the Charter.Similarly, the right to be free from crueland unusual treatment is not violated be-cause a prohibition against physician-assisted suicide does not constitute a form

of "treatment". And even if the prohibitionviolated Rodriguez’ right to equality in law,a separate provision of the Charter allowsfor such violations in cases where they are"demonstrably justified" as a reasonablelimitation prescribed by law. :

In dissent, Supreme Court Chief JusticeAntonio Lamer argued that Rodriguez’physical disability creates an inequalitybecause it prevents her from committingsuicide, which is not illegal in Canada. Forpeople like her, "the principles of self-determination and individual autonomy,which are of fundamental importance inout legal system, have been limited" andthey are thus victims of discrimination. :Madam Justices Claire L’Hereux-Dube

and Beverly McLachlin argued that Rodri-guez’ right to security of the person wasinfringed because the effect of a distinctionbetween lawful suicide and unlawful assis-ted suicide "is to deny to some people thechoice of ending their lives solely because

they are physically unable to do so, preven-ting them from exercising the autonomyover their bodies available to other people".

Also dissenting was Justice Peter Cory,who noted that "the right to die with

dignity should be as well protected as is anyother aspect of the right to life. State

prohibitions that would force a dreadful,painful death on a rational but incapa-citated terminally ill patient are an affrontto human dignity". "There is no differencebetween permitting a patient of soundmind to choose death with dignity byrefusing treatment and permitting a patientof sound mind who is terminally ill to

choose death with dignity by terminatinglife preserving treatment, even if, becauseof incapacity, that step has to be physicallytaken by another on her instructions", headded.

Wayne Kondro

Anencephalic baby’s right to life?

In a decision that has surprised many legaland ethics experts in the United States, aUS District Court Judge has ruled that ahospital must provide aggressive life-

sustaining treatment to an anencephalicinfant, including mechanical ventilation, ifthe infant’s mother requests it. The rulingwas issued last July, but because of an ordersealing the court documents, details of the :case became public only recently, when thejudge, Claude M Hilton, published hisopinion. :The case concerns the care of an infant,

referred to in the judge’s opinion as BabyK, who was bom on Oct 13,1992, at FairfaxHospital, a 656-bed facility in the Wash-ington DC suburb of Falls Church,Virginia. The anencephaly had been diag-nosed prenatally, but the mother, referredto as Ms H, had refused to have thepregnancy terminated. The child was de-livered by caesarean section and, because ofrespiratory distress, was immediatelyplaced on a mechanical ventilator. Within afew days of the birth, hospital medicalpersonnel asked the child’s mother for

permission to issue a "Do Not ResuscitateOrder" to allow withdrawal of the ventila-tor support, arguing that such treatmentwas futile and inappropriate in a case inwhich no cure or palliation was possible.The mother, however, refused. "Ms H hasa firm Christian faith that all life should be

protected", Judge Hilton wrote. "She be-lieves that God will work a miracle if that isHis will. Otherwise, Ms H believes God,and not other humans, should decide themoment of her daughter’s death."Over the past year, the child has

repeatedly required mechanical venti-

lation, reportedly spending a total of fourmonths in the hospital’s paediatric inten-sive care unit. After consultation with anethics committee, the hospital went to court

to seek a judicial declaration that it wouldnot be in violation of a number of Federaland State laws forbidding discriminationagainst the handicapped, if they were torefuse to treat Baby K despite the mother’swishes. Judge Hilton, however, concludedthat not only did Federal anti-discrimination statutes say that the hospitalcould not refuse the mother’s request for

aggressive medical support but also foundthat the mother’s right to insist ontreatment was protected by the US Consti-tution. The Fourteenth Amendment to theUS Constitution protects the right ofparents to bring up their children, Hiltonsaid. "These constitutional principles ex-tend to the right of parents to make medicaltreatment decisions for their minor child- Iren." Hilton concluded that the FirstAmendment, which guarantees the freeexercise of religion, also applied, becausethe mother’s decision was based on a

religious conviction that all life is sacred. :Dr Michael Grodin, head of the Program

of Medical Ethics at Boston UniversitySchool of Medicine, calls the case "out-rageous". Grodin says that, althoughparents should have enormous discretion in

making decisions about their children’smedical care, they do not have the right tomake demands of this extreme. "If weaccept this argument, then, I would argue, :this mother has the right to demand a hearttransplant, a liver transplant, dialysis,as well as the ventilator," Grodin said.

: George Annas, director of the Law, Medi-cine and Ethics Program at Boston Univer-

: sity, predicted that the ruling, which is vbeing appealed to the Fourth Circuit of theUS Court of Appeals, would be overtur-ned. "In all the statutes cited, Congress

: made it clear and the courts that have: interpreted them have made it clear that .... doctors are supposed to follow reasonable

nedical judgments. That’s what doctorstre there for", Annas said. But Robert MVeatch, director of the Kennedy Institute)f Ethics at Georgetown University, dis-tgrees. "What is at stake is the value ofunconscious life and that seems to me not tobe a medical-scientific question but a philo-sophical or religious question." Veatch:ontends that until society arrives at a

:onsensus on this issue, the decision to treator not to treat in cases such as these shouldbe left to the parent. "I think the core issues whether physicians who are acting pri-vately and as individuals can be so sure thati baby should be dead that they can make:he baby dead against the mother’swishes."

Michael McCarthy

Poggiolini’s possessions

Although now 18 months old, the murkydrama of corrupton in Italian public life ishardly beyond its first act. The namecoined by the press, "Tangentopoli"("Bribe City"), as a convenient term withwhich to refer to the apparently limitlessskulduggery now being uncovered, hassired a subtitle "Sanitopoli" for the shadydealings in the area of medicine and publichealth. The case of ex-minister FrancescoDe Lorenzo (see Lancet July 17, p 166),pales before the latest revelations aboutDuilio Poggiolini.

Poggiolini, 64, has enjoyed a meteoriccareer, with professorial appointments inmicrobiology (in 1963 at age 34), che-

motherapy (1966), and hygiene (1972 in theFaculty of Pharmaceutical Science, Rome).In 1973 he became director-general of thePharmaceutical Service. Subsequently hebecame a member of the CIP, whichestablishes drug prices in Italy, and presi-dent of European Committee for Proprie-tary Medicinal Products (CPMP). All this