Therapeutic Ratio and Defined Phases: Proposal of Ethical Framework for Palliative Care

Abstract

The everyday practice of oncology and palliative care raises complex moral issues. Examples include: When should radical curative treatment be stopped -- or rejected from the outset as an option? Do measures for the relief of symptoms shorten life? When should active drug treatments -- for example, antibiotics and steroids -- be stopped? (Similar questions can be asked about support of physiological systems: blood transfusion, ventilation, renal dialysis, intravenous hydration and nutrition.) What steps should be taken when food and drink can no longer be taken by mouth? How should we deal with differences of opinion about management arising among patient, family, and carers? What is the relation between euthanasia and palliative care? We propose to examine these questions in a framework that divides the therapeutic interaction into three phases or modes: curative, palliative, and terminal.