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Results for “Deciding to Forego Life-Sustaining Treatment”

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At least 19 recordsLinked to original sources
PubMed1985

The shared burden: when physicians and families decide to forego life-sustaining treatment.

Family physicians are being called upon to make decisions regarding whether to forego life-sustaining treatment. These decisions are made based on consultation with the family of the patient but are complicated by problematic family interactions. The family physician can manage difficult family reactions and assist the family in making a decision by understanding that there are common reactions to loss and bereavement on the part of family members such as anger, denial, and feelings of helplessness; assessing whether problems arise from chronic family conflicts (marital, parent-child, or previous unresolved mourning) or are situation related (unexpressed feelings, how to tell others, need to feel they have done everything, overwhelming other stresses); and incorporating several specific techniques into their practices such as family conferences, accepting anger, involving anxious members in treatment planning, referral to self-help family groups, reframing the decision in terms of the patient's wishes, and negotiating mutually acceptable solutions when patient or family members disagree.

Family↗
PubMedDate not supplied

Decisions about life and death: assessing the Law Reform Commission and the Presidential Commission Reports.

This paper compares the critically comments upon certain aspects of the Canadian Law Reform Commission Report, Euthanasia, Aiding Suicide and Cessation of Treatment, and the United States Presidential Commission Report, Deciding to Forego Life-Sustaining Treatment. It focuses on their positions on euthanasia and on the general principles, values, and procedures that ought to govern practices of foregoing life-sustaining treatment. The paper first comments on the recent debate over the moral relevance of the killing/letting die distinction, since this issue appears crucial in assessing the rationality of the current, absolute prohibitions of direct killing in medical contexts, embodied both in law and in codes of ethics. This issue bear upon a question in the closing section--whether the withdrawal of foods and fluids is ever morally permissible.

Advisory Committees↗
PubMed1995

"Playing God" and the removal of life-prolonging therapy.

"Playing God" is the charge frequently leveled when physicians and patients agree to withdraw life-sustaining medical treatments and let the patient die. The accusation rings hollow in the context of four hundred years of moral reflection on the duty of an individual to undergo medical treatments to preserve life. From the teachings of Soto and Banez in the 16th century through the President's, Commission 1983 report 'deciding to forego life-sustaining treatments' there is a clear and constant teaching that though life is sacred it is not an absolute and our moral duty to preserve it is limited and based on rational reflection. No patient need undergo any treatment of procedure that is "disproportionately" costly, burdensome, or painful. The assessment of whether to accept or reject a proposed treatment is in part subjective and belongs to the individual patient. The only remaining issue is how to make that judgement for those unable to speak for themselves.

Euthanasia, Active↗
PubMed1992

Community hospital ethics consultation: evaluation and comparison with a university hospital service.

BACKGROUND: Ethics consultants may improve patient care by responding to physician requests for assistance with problems they identify as ethical issues. OBJECTIVE: To examine three aspects of ethics consultation: the clinical questions asked; the helpfulness of the consultation to requesting physicians; and the differences between consultations performed at a community teaching hospital and those performed at a university hospital. SETTINGS: A community teaching hospital and a university teaching hospital. SUBJECTS: Physicians who formally requested ethics consultations in both hospitals and the patients for whom they requested them. METHODS: Over 2 years (January 1, 1988, to December 31, 1989), we prospectively evaluated a newly established clinical ethics consultation service in a community teaching hospital using confidentially completed, pretested, structured questionnaires, and compared our data with previously reported university hospital data. RESULTS: During the 2-year study, 104 consultation requests were received from 68 physicians in eight departments. Requesters most often requested consultation about deciding to forego life-sustaining treatment (74%), resolving disagreements (46%), and assessing patient competence (30%). Requesters found the consultation "very helpful" or "helpful" in one or more aspects of patient care in 86% of cases, or in one or more aspects of physician education in 86% of cases. These data are similar to university hospital data.

Adolescent↗
PubMed1984

Ethics Commission examines moral distinctions in using life supports.

Deciding to Forego Life-Sustaining Treatment, a report of the President's Commission for the study of Ethical Problems in Medicine and Biomedical and Behavioral Research, examines four common medical-ethical distinctions. The report highlights the 1980 Declaration on Euthanasia and closely follows Catholic moral teaching on the following. Death by action versus omitting to act. The commission rejects the idea that a physician who fails to act should not be held responsible for a patient's death. Failing to resuscitate, for example, or to take other steps to prolong life, are just as much causes of death as a lethal injection. The health profession's traditional duty to act on the patient's behalf precludes any distinction between acts and omissions. Withdrawing versus withholding treatment. Acknowledging that initiating treatment may create an obligation to continue treatment, the commission suggests that distinguishing between withholding and withdrawing could encourage undertreatment and overtreatment. Fear of being unable to withdraw unsuccessful treatment could lead to physicians' failing to treat patients who might benefit from the therapy. Ordinary versus extraordinary means. The commission upholds this distinction. It suggests, however, that the phrase "proportionate versus disproportionate" better describes the moral issue involved in selecting treatments that, in relation to their expected benefits, impose no excessive burden on the patient or family. Regarding intended versus unintended consequences, the commission departs from Catholic tradition. It fails to acknowledge the significance of physicians' intentions. What matters instead, according to the commission, is whether physicians act within their authority as defined by society. Thus, the commission suggests, the use of pain medications that may cause death can be socially and legally acceptable.

Ethics, Medical↗
PubMed1985

Ethics committee develops supportive care guidelines.

In response to widespread physician noncompliance with "do not resuscitate" (DNR) guidelines in 1983, the ethics committee at St. Joseph's Hospital, St. Paul, MN, set out to clarify the confusion over "supportive care only" (SCO) and DNR orders. A task force of nurses and physicians developed tentative supportive care guidelines and a subcommittee related ethical principles to the supportive care concept. The completed draft, "Principles and Guidelines in Deciding to Forego Life-Sustaining Treatment," was reviewed by the medical executive board and hospital attorney. St. Joseph's medical staff and board of trustees approved it in May 1985, and the document became hospital policy. The policy addresses patient autonomy, the burden/benefit principle, informed consent, and patient competency. It lists six guidelines for making supportive care plans. St. Joseph's has implemented the policy in several ways. Committee members make "ethics rounds" to discuss patient cases and the guidelines with hospital personnel. A brochure acquaints patients and their families as well as community groups with the guidelines. Nurses have introduced the guidelines to physicians in critical care units. When necessary, new insights will be incorporated into the guidelines.

Catholicism↗
PubMed1997

Withholding and withdrawal of life support: ethical, legal, and clinical aspects.

The withholding and withdrawal of life support are processes by which various medical interventions either are not given to or are taken away from patients, with the expectation that they will die as a result. The propriety of withholding and withdrawal of life support has been supported by ethical statements from groups such as the Task Force on Ethics of the Society of Critical Care Medicine, and by a series of legal decisions beginning with the Quinlan case. Surveys of healthcare professionals indicate that most ICU physicians withhold and withdraw life support on a regular basis, that they consider these processes ethically equivalent, that they recommend withholding and withdrawal of life support based upon prognosis (which may be expressed as futility), and that they consider patient and surrogate wishes to be most important in deciding to forego life-sustaining treatment, but place these wishes in the context of their own assessment of prognosis. Observational studies show that: withholding and withdrawal of life support occur frequently, the frequency has increased over the past several years in some ICUs, patients and families generally agree with physician recommendations to limit care or request such limitation, disagreements sometimes occur on this issue, withdrawal of life support occurs more commonly than withholding of life support in most ICUs, cardiopulmonary resuscitation is the therapy most frequently withheld, mechanical ventilation is the therapy most frequently withdrawn, this withdrawal process usually is gradual, and it usually is facilitated by the administration of sedatives and analgesics. Clinical information such as this is helping to define a standard of care in the area of withholding and withdrawal of life support.

Critical Care↗
PubMedDate not supplied

The stability of preferences for life-sustaining care among persons with AIDS in the Boston Health Study.

BACKGROUND: Clinicians recognize the importance of eliciting patient preferences for life-sustaining care, yet little is known about the stability of those preferences for patients with serious disease. OBJECTIVES: To examine the stability of preferences for life-sustaining care among persons with AIDS and to assess factors associated with changes in preferences. DESIGN: Two patient surveys and medical record reviews, administered four months apart in 1990-1991. SETTING: Three health care settings in Boston. PATIENTS: 252 of 505 eligible persons with AIDS who participated in both baseline and follow-up surveys. MAIN OUTCOME MEASURES: A single question assessing desire for cardiac resuscitation and a scale of preferences for life-extending treatment conditional on hypothetical health states. RESULTS: Approximately one-fourth of the respondents changed their minds about life-sustaining care during a four-month period. Of patients who initially desired cardiac resuscitation, 23% decided to forego it four months later, and of those who initially said they would decline care, 34% later said they would accept it. Of those who initially desired any of the life-extending treatments, 25% decided to forego them four months later, and of those who initially said they would decline life-extending care, 24% later said they would accept some treatment. Patients reporting changes in physical function, pain, or suicide ideation were more likely to modify their desires to be resuscitated (all p< or =0.05). Patients lacking an advance directive, not completing high school, or becoming more severely ill were more likely to change their preferences on the Life Extension scale (p< or =0.05). Patients who discussed their preferences with at least one physician were just as likely as others to change desires for cardiac resuscitation. Age, gender, race, emotional health, clinical severity, social support, and site of care were not significant correlates of change for either measure. CONCLUSIONS: Health care providers should periodically reassess preferences for life-sustaining care, particularly for patients with progressive disease, given the instability in patient preferences. However, predictors of instability may vary with how preferences are measured. In particular, changes in health status may be related to instability of preferences for certain types of treatments.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Is the patient's right to die evolving into a duty to die?: Medical decision making and ethical evaluations in health care.

When patient or family requests for continued life-sustaining treatments conflict with doctor recommendations, different conclusions as to what is beneficial for the patient may arise. Past practices usually accepted patient or family requests based on the principle of autonomy or that the doctor's primary responsibility is to the individual patient. Many patients die in intensive care units after doctors forego life-prolonging interventions. Health care changes and cost containment have led to a change in the classical ethical model of the patient-doctor relationship such that concerns for societal requirements increasingly overrule those for individual patient needs. The ability to keep patients alive with little likelihood of recovery and the recognition of escalating health costs have led to calls for the needs of society and distributive justice to be taken into account. A tendency to justify a duty to die for these patients has arisen. Recent legal decisions in cases with conflicts between families and health care providers and institutions over foregoing life-sustaining therapies have decided for the families against doctors and hospitals, compelling institutions and their staff to act contrary to their ethical views. Value judgments of doctors are sometimes confused with medical indications for therapy. Doctors have defined therapies as futile or non-beneficial based on their own values and even withdrawn life-sustaining treatments without patient or family input. In some cases, the right to die is leading to the duty to die even against patient or surrogate wishes. Such observations indicate the need for rigorous analyses of medical decision making in this context and for ethical evaluations in health care in general.

Attitude to Death↗
PubMed1986

Selected bibliography of recent articles in ethics and geriatrics.

The disciplines of bioethics and geriatrics have had parallel development in recent years. From small and relatively esoteric fields 15 or 20 years ago, both have grown enormously. Although the numbers of geriatricians and ethicists in practice or in academic centers have increased substantially, these disciplines represent areas in which better understanding is sorely needed. This bibliography is intended to assist the clinician in locating salient literature concerning bioethical issues in geriatric medicine and research. It is highly selective; it does not attempt to cover all the literature on bioethics. There are several excellent general bioethics bibliographies for clinicians in the recent literature, as well (not limited to clinical journals or clinical topics), some of which are included in section 13 for the reader's further information. The ethical issues that arise in geriatric medicine are similar to those that arise in the care of younger patients, but certain kinds of problems happen with far greater frequency. Dilemmas concerning decisions about care at the end of life are particularly relevant in geriatrics, as persons of extreme old age are often presented with choices about life-sustaining therapy when critical illness occurs. This includes decisions about cardiopulmonary resuscitation and nutritional support. When these clinical decisions arise in the care of patients who cannot decide for themselves, the question arises as to what role the assessment of "quality of life" ought to play in decisions to pursue or to forego life-sustaining therapy. Informed consent to treatment and to participation in research has been an important area of ethical investigation. Dilemmas about consent to treatment are complicated in some elderly populations because of the higher incidence of cognitive impairment and the higher incidence of the clinician's suspicion (or assumption) of cognitive impairment. In consent to research, there are additional issues of voluntariness and equitable selection, especially when subjects are residents of nursing homes. Because of the increasing numbers of elderly persons in our society, and because of the role of social resources (federal, state, and local) in acute and long-term medical major concern in gerontologic bioethics. The topic headings for this bibliography reflect these common issues which arise in the care of the elderly.+2

Bibliographies as Topic↗