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Results for “Euthanasia, Passive”
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Easing the burden of decisionmaking in futile situations.
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Ethical and practical considerations of withdrawal of treatment in the intensive care unit.
PURPOSE: To discuss the medical, ethical and legal basis of decisions to discontinue life-support therapy in the adult intensive care unit (ICU), and to provide practical guidelines for the discontinuation of life support therapy. SOURCE: Relevant articles were retrieved through Medline (1991-present; terms: ethics, life support discontinuation, double effect, beneficence, non-maleficence). Other sources include legal references, and personal files. PRINCIPAL FINDINGS: Understanding the legal and ethical principles of autonomy, beneficence, non-maleficence and double effect are crucial when withdrawing life support therapy. The law respects a competent patient's right to direct his/her healthcare but does not uphold his/her right to demand futile care. Surrogate decision makers can be used when the patient is incompetent, provided they are acting in the patient's best interest. Euthanasia is illegal and the distinction between discontinuation of therapy and euthanasia is legally clear. Skillful administration of palliative therapy cannot be construed as euthanasia when the aforementioned ethical principals are respected. The various practical methods of discontinuing therapy are discussed. Every ICU should develop its own guidelines and a checklist to help caregivers during this difficult time. Caregivers must anticipate the mechanism of death and direct interventions at the symptoms that are likely to cause discomfort. Drugs and dosages must be individualized, and depend on the underlying disease, anticipated mechanism of death, and the patient's pharmacological history. When prescribing a drug, the intention should be clear. CONCLUSIONS: Appropriate discontinuation of therapy in the ICU allows patients a dignified and comfortable death.
End-of-life: the traditional Christian view.
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No obligation to resuscitate a non-viable infant.
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Regulating the foregoing of artificial nutrition and hydration: first, do some harm.
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The rise and fall of the futility movement.
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Elderly patients' views on cardiopulmonary resuscitation.
A survey was conducted by means of a questionnaire to assess elderly patients' perception of cardiopulmonary resuscitation (CPR) as it might be applied to themselves. Nearly half (47%) of patients were unaware of the existence and practice of this procedure. The majority of patients felt that selective application of CPR in the elderly was appropriate. Factors that may influence selection are discussed. A considerable proportion of patients wished to be resuscitated if the need arose--a fact not in keeping with the scant information available on the subject. Significantly more men than women favoured resuscitation. Some elderly people interviewed, favoured resuscitation of elderly patients other than themselves. Patients welcomed an opportunity to discuss and express their views on their position.
. . . and a time to die: the medicine of old age.
Most deaths in Britain occur in old age, and old people dying have as many symptoms as do the young. Management is complicated by diagnostic difficulty, by the frequency of mental disorder (sometimes treatable) and of severe disability, and by the difficulty in ascertaining patients' feelings. Decisions about the management of dying are inevitable, and multifactorial, and views of others may be helpful. Cardiopulmonary resuscitation is not indicated if futile, and may or may not be wanted by the patient. Withholding or withdrawing life-prolonging treatment may be justified if the totality of life gained (length and quality) is not justified by the burden of treatment. Decisions are most difficult when the prognosis is poor but not definitely fatal. Palliative care is important, not only in cancer. Euthanasia is seldom requested at present, and in The Netherlands is carried out less in old people than young. It would do little for the most serious problems of old age.
Ethical considerations in treating oncology patients in the intensive care unit.
The care of oncology patients within an intensive care unit (ICU) setting poses an added dimension of ethical concerns faced by practitioners. This article reviews/highlights some of the issues confronting ICU staff when caring for an oncology patient. The issues addressed include: access/admission of the oncology patient to the ICU, advance directives, and the withdrawal of life-sustaining treatments.
Potential hazards of changing attitudes regarding the critically ill patient.
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When a newborn cannot survive: what nurses really believe.
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Medical futility and life-sustaining treatment decisions.
By focusing our attention on the questions of "what are we trying to achieve" and "are we able to do it", the discussion of medical futility has contributed an important dimension to the ethics of treatment decision making near the end of life. It is not simply enough to ask and answer the question of what the patient wants. Healthcare professionals have a responsibility to offer only those life-sustaining efforts that have a reasonable chance of being beneficial. Futility policies should permit treatment-limiting decisions to be made without the agreement of the patient or surrogate at times, but such policies should also provide opportunities to challenge a judgement of futility. Above all, such policies should not be used as a reason to avoid communication. Patients or surrogates need to be informed about what treatments are options and what are not. The futility criterion for limiting treatment should be recognized as a means of contributing to communication and discussion regarding benefits, harms and medical goals. It should not be permitted to bypass such discussions. The recognition of the significance of the concept of futility means that discussion needs to continue at another level as well. The questions of "what are we trying to achieve" and "are we able to do it" are not easily answered. It is especially important, we think, that those who are experienced in working with patients with neurological impairments contribute to the on-going reflection on what constitutes benefit or what is the appropriate use of life-sustaining interventions for such patients.
Ethical issues in the management of geriatric cardiac patients.
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Withholding and withdrawing of life sustaining treatment in the newborn.
The rapid progress of medical technology has resulted in more opportunities to maintain the life of infants in serious and potentially life threatening situations. Whether to treat such infants is a common dilemma. The burden of these difficult decisions rests almost equally on distraught parents and relatives and on the professional staff of neonatal units. Sometimes, either parents or care teams choose to seek a decision from the courts. Ways of reaching the best possible and most inclusive consensus decisions are examined in this review.
One man's burden.
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