Preface.

• Author: Bopp, James, Jr.

The first article in this edition of Issues in Law & Medicine provides a critical evaluation of palliative care in the Netherlands. Dr. Raphael Cohen-Almagor, senior lecturer, University of Haifa, Israel, conducted twenty-eight interviews in the Netherlands during the summer of 1999 with some of the leading figures who dictate the decision-making process and take an active part in the debates. This study reports data gathered via the interviews in response to the following question: It has been argued that the policy and practice of euthanasia in the Netherlands is the result of undeveloped palliative care. What do you think? The interviewees were also told that there are only a few hospices in the Netherlands.

The responses were different and contradictory. Many interviewees agreed with the statement. Almost all of those agreeing with it said that only during the late 1990s were people beginning to admit that there was a need to improve palliative care. Some interviewees insisted that doctors first need to explore other options for helping the patient prior to choosing the course of euthanasia. Other interviewees thought that palliative care is well developed in the Netherlands and that euthanasia has actually paved the way for calling more attention to palliative care.

Professors K. G. Karakatsanis, M.D. and J. N. Tsanakas, M.D., in the second article, report that since the concept of "brain death" was introduced in medical terminology, enough evidence has come to light to show that the concept is based on an unclear and incoherent theory. The "brain death" concept suffers by internal inconsistencies in both the tests-criterion and the criterion-definition relationships. It is also evident that there are residual vegetative functions in "brain dead" patients. Since the content of consciousness is inaccessible in these patients who are in a profound coma, the diagnosis of "brain death" is based on an unproved hypothesis. The authors provide a critical evaluation of the role and the limitations of the confirmatory tests in the diagnosis of "brain death."

The Verbatim section includes six items of interest. First, the Brief Amici Curiae of C. Everett Koop, M.D., Sc.D., et al., filed in support of Attorney General Ashcroft in the United States Court of Appeals for the Ninth Circuit argues that the historical record and current professional consensus favors the conclusion that assisting suicide is not a "legitimate medical purpose," and in...