Participant: Maria do Céu Rueff
Affiliation: Universidade Lusíada, CEJEA/FCT, Centro de Direito Biomédico da Faculdade de Direito da Universidade de Coimbra
Format: Presentation and Conversation
Themes: paradigm, praxis

I will problematize medical performances at the end of life, confronting them with the responses of Portuguese Criminal Law. I will start from a review of literature, both in Portugal and abroad, by crossing the criminal doctrine with a broader, interdisciplinary approach, including the reconsideration of the medicine ethical tradition.

I will place my paper in a medical law integrative perspective, opened by authors like the German Eser (2004), who speaks about the specificity of the field characterized by a medical-legal approach starting from the centre, based on a (medical-legal) trans-disciplinary method and taking into account border sciences. Therefore, I will consider recent developments in neuroscience.

The frame of homeostasis (neurobiology of emotions) by Damasio (2003), with compassion in the top, helps to clarify to which extent medical act according to leges artis becomes the centre of the problem. Indeed, it is within the medical act, understood as the meeting of two autonomies – patient’s and doctor’s autonomies – that the compassion takes place, as a result of the agreement/compromise between the patient’s will of ceasing her/his life in a situation of unbearable suffering and the doctor’s duty to relieve that suffering. Compassion arises here as a “homeostasis instrument”, that is, an emotion which is important in the regulation of life, even when we are speaking about end(ing) of life. This new perspective allows us to guess a shift of paradigm on the ethical and social levels.

On the other hand, in so far as we have passed from the compassionate response in medical setting to its discussion, successively, in medical ethics, in the courts, and as a normative instrument, I claim that we are before the “transition from an automatic homeostasis to a deliberate homeostasis” (Damasio, 2003). Therefore, I seek for a balance between the spontaneous and the planned, concerning the issue of praxis. Indeed, what increasingly happens in medical praxis should be brought together with theory, whereby cybernetics has a word to say.