The Ethics of Withholding and Withdrawing Critical Care
Sanders, Lee M.
Raffin, Thomas A.
Cambridge Quarterly of Healthcare Ethics. 1993 Spring; 2(2): 175-184.
For the 17 centuries since Hippocrates called for "the most desperate remedies in desperate cases," physicians have adhered steadfastly to two cooperative goals: to prolong life and to relieve suffering. But during the past 50 years, mechanical interventions at the edge of life have thrown those aims into dramatic conflict. Cardiopulmonary resuscitation, mechanical ventilation, feeding tubes, and the intensive care unit have postponed physiologic death for many patients who are anencephalic, comatose, or in a persistent vegetative state or prefer death to a life of suffering and pain. Demands from patients' families and cries for social justice have compelled physicians, hospital personnel, and the Supreme Court to analyze concepts long reserved for university philosophers. Although decisions are made daily to withhold and withdraw life support, society is gradually agreeing upon an ethical framework that balances hopeful science with dignified death. This article outlines that ethical framework, reviews recent legal precedents, and suggests practical guidelines for their application.
Advance Directives; Allowing to Die; Artificial Feeding; Autonomy; Beneficence; Brain; Brain Death; Communication; Consent; Death; Decision Making; Disclosure; Ethics; Family Members; Futility; Goals; Guidelines; Justice; Legal Aspects; Life; Pain; Patients; Persistent Vegetative State; Physicians; Privacy; Prognosis; Prolongation of Life; Resource Allocation; Resuscitation; Resuscitation Orders; Right to Die; Science; Standards; Suffering; Terminal Care; Third Party Consent; Ventilators; Withholding Treatment;
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