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Life support: the doctor's dilemma--moral issues.

The doctor's dilemma regarding life support arises from opportunities in modern medicine to prolong life beyond the wildest dreams of medical doctors in previous eras. The traditional ethical framework based on duties to respect life, do what is best for the patient, be faithful to patients' reasonable expectations and avoid doing harm provides an adequate general guide for practitioners regarding what they are ethically required to do and must refrain from doing. However, a third category, ethical permissibility, allows for conduct that may not be ideal but is the most ethical in life-support dilemmas. Discussions of withholding and withdrawing life support, ordinary and extraordinary measures, proportionality and medical futility are enriching today's ethical debate about ethically permissible conduct in such situations.

Ethics, Medical↗

Abuse of futility.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗

Treatment refusal: the beliefs and experiences of Alberta nurses.

This study explored the beliefs and experiences of Alberta nurses concerning withholding and withdrawal of treatments from incurably or terminally ill patients. A mailed survey containing closed and open-ended questions was used to gather data. A response rate of 47% was achieved. The majority of respondents believed patients should legally be able to request that treatments be withheld (98%) or withdrawn (97%). More than half of the respondents had received requests from patients, families or physicians to withhold or withdraw treatments. Occasionally, nurses acted without physicians' knowledge. Three different positions with respect to decision-making in withholding and withdrawing of care, 'subordinate', 'collaborative' and 'independent', emerged from nurses' written comments on the questionnaire. Consensus among health care practitioners and consumers is critical to end-of-life decision-making.

Adult↗

End-of-life decisions in neonates.

In a large percentage of the infants who die in the neonatal intensive care setting, an end-of-life decision was made before death, usually a decision to forego life-sustaining treatment. This was confirmed in a recent study in The Netherlands that showed also that a minority of cases include the administration of drugs to hasten death, usually in patients with severe congenital multiple or central nervous system anomalies. Over 80% of Dutch pediatricians support this option under certain conditions. Almost all pediatricians are of the opinion that these cases have to be subject to public review, but they favor review by a committee of independent medical, judicial, and ethical professionals rather than by the public prosecutor. A discussion group on this subject recently made a proposal for such a reviewing procedure to the Dutch governmental authorities and described the requirements concerning end-of-life decisions in neonatal medicine. Proper handling of ethical aspects of medical treatment including review and feedback after end-of-life decisions can contribute to high standards of quality of care.

Abnormalities, Multiple↗