This article has been cited by other articles in PMC. Abstract Withholding or withdrawing a life-sustaining treatment tends to be very challenging for health care providers, patients, and their family members alike.
Life-Sustaining Treatment and Euthanasia: In most Western societies, the Judeo-Christian religious tradition has given great importance to the sanctity of life. Modern medicine has also gained extraordinary new powers to prolong life. Within the last few decades, medical treatments such as kidney dialysis, cardiopulmonary resuscitationorgan transplantation, respirator support, and provision of food and water by artificial means have become common in hospitals.
While these new treatments often benefit patients, restoring them to well-functioning lives, they also can be employed in circumstances where they may be neither a benefit to nor wanted by patients.
This entry will first develop an ethical framework for life-sustaining-treatment decisions around which a considerable, though hardly universal, consensus has developed, and contrast it with the distinction between ordinary and extraordinary care. It will then consider broad alternative positions on the morality of taking life and some of their implications for care of the dying.
Focusing on more specific controversies, it will then address the Euthanasia death and life sustaining treatment taking of life versus pain relief that hastens death, killing and allowing to die, not starting versus stopping treatment, and four prominent examples of end-of-life treatment—resuscitation, artificially administered food and water, terminal sedation and futile treatment.
Finally the entry will conclude with discussions of life-sustaining treatment and suicide and of physician-assisted suicide and voluntary euthanasia. An Ethical Framework for Life-Sustaining-Treatment Decisions An ethical framework for life-sustaining-treatment decisions should be sufficiently general to apply to all forms of such decisions and to both competent and incompetent patients.
In the United States in the twentieth century, healthcare-treatment decision making came increasingly under the dominion of the ethical and legal doctrine of informed consent. This doctrine requires that treatment not be administered without the informed and voluntary consent of a competent patient.
Patients, on the other hand, use their own aims and values to discern and decide which option is best for them. Shared decision making is based on the recognition that sound, individualized-treatment decision making requires both contributions.
The principal ethical values that underlie shared decision making involve promoting the well-being of patients while respecting their self-determination or autonomy. It is also meant to signal the extremely important point that preserving or sustaining life is not always a benefit to patients; whether it is depends on the nature of the life sustained and whether the patient values that life.
Self-determination is the interest ordinary persons have in making important decisions about their lives for themselves and according to their own values or conception of a good life.
The capacity for self-determination allows people to take control over and responsibility for their lives and the kind of persons they become. The fundamental importance of self-determination has consistently been the central appeal in the United States both in the long line of informed-consent legal cases going back at least as far as the case Schloendorf v.
Society of New York Hospital, and in the more recent life-sustainingtreatment cases. On the basis of these two values, as well as the ideal of shared decision making and the requirement of informed consent they support, competent patients have the right to weigh the benefits and burdens of alternative treatments, including the option of no treatment, and to make their own selection.
While this ethical framework applies to any treatment, it provides especially strong support for patients deciding about life-sustaining treatment.
When forgoing life-sustaining treatment is seriously in question, the patient is often critically or terminally ill and near death and also often in a seriously debilitated state. Whether a particular patient will want to fight to stay alive as long as possible, or will instead at some point find continued life no longer a benefit but now a burden, is highly variable and unpredictable.
When forgoing life-sustaining treatment is seriously in question, patients are often— probably usually—incompetent to make the decision for themselves, and so another person must decide for them.
Bioethics and the law have given much attention to who should decide about life support for incompetent patients and what standards should be used. A number of ethical grounds support the common practice, employed by physicians and sanctioned by the courts, of turning to a close family member of the patient, when one is available.
Moreover, a close family member will usually know the patient best and will therefore be in the best position to determine what the patient would have wanted.
This person is also likely to care most about doing what is best for the patient. Finally, in most societies the family is the social unit in which important social bonds and responsibilities to care for dependent members are developed; one exercise of this responsibility is to serve as surrogate for an incompetent family member.
These ethical grounds usually, but do not always, apply and so can be thought of as establishing an ethical presumption that a close family member is the appropriate surrogate to make life-sustainingtreatment decisions for an incompetent patient.
When these reasons do not apply—for example, when there is evidence that the patient would have wanted someone else to serve as surrogate or there is a serious conflict of interest between the family member and surrogate—then the presumption in favor of the family member as surrogate can be rebutted and another should be selected to serve instead.
How should a surrogate make life-sustaining-treatment decisions for an incompetent patient? First, if the patient has made an advance directive e. Second, when most patients do not have an advance directive or their advance directive is too general to determine the actual treatment decision, the "substituted judgment" standard should be used.
This directs a surrogate to attempt to make the decision that the patient would have made, in the circumstances that then obtain, if the patient were competent. This often amounts to asking what most reasonable persons would want; in the absence of available evidence about how, in relevant respects, the patient is different from most people, this is justified.
These three standards constitute a way to promote patient well-being and self-determination to the extent possible when the patient lacks capacity to make decisions. These standards have not gone unchallenged Meisel; Veatch; Dresser and Whitehead.
For example, parents are given significant discretion, especially in the case of young children, in deciding what would be best for their child and are permitted to give some weight to the effects of different options on important interests of other family members.
The authority of both advance directives and substituted judgment have also been challenged when following them would conflict with important interests of the now-incompetent patient or when the patient has undergone such profound mental changes that he or she appears to be a "new person" with new interests.
Despite the substantial consensus on the ethical framework sketched above, it is not uncontroversial. This ethical framework for life-sustaining-treatment decisions by competent and incompetent patients does give weight to a narrowly focused quality-of-life judgment: This decision-making framework has now largely supplanted the distinction between ordinary and extraordinary treatment.
Ordinary versus Extraordinary Care The distinction between ordinary and extraordinary care has its origins in Roman Catholic moral theology, where it is employed to distinguish between obligatory care—ordinary— and care that may be permissibly forgone—extraordinary.Neonatal Euthanasia: The Groningen Protocol American College of Pediatricians – January End of life decisions were: to forego life sustaining treatment in 57%; to administer potentially life shortening drugs to treat the pain and suffering in 23%; and to give a drug to hasten death in 8%.
withholding treatment and giving lethal. The Society of Life and Death Education clarifies the concept of euthanasia as below: Euthanasia, according to the medical profession’s definition, is the direct and . The research tools used included the Concept of Good Death Measure (CoGD), the measurement tool for attitudes towards withdrawal of meaningless life-sustaining treatment (WoMLST), and the measurement tool for attitudes towards euthanasia.
Death and Dying - Chapter Medical Law, Ethics, and Bioethics.
STUDY. PLAY. What is active euthanasia? What is withholding life-sustaining treatment? Most states accept the definition of death as brain-oriented death, except which state? New Jersey. Euthanasia: Death and Life-sustaining Treatment Essay Euthanasia and Physician Assisted Suicide Debate HCA Judith Watkins December 8, Euthanasia and Physician Assisted Suicide Debate Physicians are committed to sustaining life and relieving suffering.
Mar 11, · Many health care providers believe that any omission of a life-sustaining treatment is tantamount to euthanasia or at least assistance in the patient’s suicide.
And health professionals are not the only ones to reason in this fashion.