Posted on 06/22/2005 9:46:20 AM PDT by BykrBayb
E-2.20 Withholding or Withdrawing Life-Sustaining Medical Treatment
The social commitment of the physician is to sustain life and relieve suffering. Where the performance of one duty conflicts with the other, the preferences of the patient should prevail. The principle of patient autonomy requires that physicians respect the decision to forego life-sustaining treatment of a patient who possesses decision-making capacity. Life-sustaining treatment is any treatment that serves to prolong life without reversing the underlying medical condition. Life-sustaining treatment may include, but is not limited to, mechanical ventilation, renal dialysis, chemotherapy, antibiotics, and artificial nutrition and hydration.
There is no ethical distinction between withdrawing and withholding life-sustaining treatment.
A competent, adult patient may, in advance, formulate and provide a valid consent to the withholding or withdrawal of life-support systems in the event that injury or illness renders that individual incompetent to make such a decision. A patient may also appoint a surrogate decision maker in accordance with state law.
If the patient receiving life-sustaining treatment is incompetent, a surrogate decision maker should be identified. Without an advance directive that designates a proxy, the patient’s family should become the surrogate decision maker. Family includes persons with whom the patient is closely associated. In the case when there is no person closely associated with the patient, but there are persons who both care about the patient and have sufficient relevant knowledge of the patient, such persons may be appropriate surrogates. Physicians should provide all relevant medical information and explain to surrogate decision makers that decisions regarding withholding or withdrawing life-sustaining treatment should be based on substituted judgment (what the patient would have decided) when there is evidence of the patient’s preferences and values. In making a substituted judgment, decision makers may consider the patient’s advance directive (if any); the patient’s values about life and the way it should be lived; and the patient’s attitudes towards sickness, suffering, medical procedures, and death. If there is not adequate evidence of the incompetent patient’s preferences and values, the decision should be based on the best interests of the patient (what outcome would most likely promote the patient’s well-being).
Though the surrogate’s decision for the incompetent patient should almost always be accepted by the physician, there are four situations that may require either institutional or judicial review and/or intervention in the decision-making process: (1) there is no available family member willing to be the patient’s surrogate decision maker; (2) there is a dispute among family members and there is no decision maker designated in an advance directive; (3) a health care provider believes that the family’s decision is clearly not what the patient would have decided if competent; and (4) a health care provider believes that the decision is not a decision that could reasonably be judged to be in the patient’s best interests. When there are disputes among family members or between family and health care providers, the use of ethics committees specifically designed to facilitate sound decision making is recommended before resorting to the courts.
When a permanently unconscious patient was never competent or had not left any evidence of previous preferences or values, since there is no objective way to ascertain the best interests of the patient, the surrogate’s decision should not be challenged as long as the decision is based on the decision maker’s true concern for what would be best for the patient.
Physicians have an obligation to relieve pain and suffering and to promote the dignity and autonomy of dying patients in their care. This includes providing effective palliative treatment even though it may foreseeably hasten death.
Even if the patient is not terminally ill or permanently unconscious, it is not unethical to discontinue all means of life-sustaining medical treatment in accordance with a proper substituted judgment or best interests analysis. (I, III, IV, V)
Issued December 1984 as Opinion 2.18, Withholding or Withdrawing Life-Prolonging Medical Treatment, and Opinion 2.19, Withholding or Withdrawing Life-Prolonging Medical Treatment -- Patients’ Preferences. In 1989, these Opinions were renumbered 2.20 and 2.21, respectively.
Updated June 1994 based on the reports "Decisions Near the End of Life" and "Decisions to Forego Life-Sustaining Treatment for Incompetent Patients," both adopted June 1991 (Decisions Near the End of Life. JAMA. 1992; 267: 2229-2233), and updated June 1996. [In March 1981, the Council on Ethical and Judicial Affairs issued Opinion 2.11, "Terminal Illness." The Opinion was renumbered 2.15 in 1984 and was deleted in 1986.]
Last updated: Jan 05, 2005 Content provided by: Ethics
bttt
ping to eye opening view from AMA, maybe we need to be interviewing our personal doctors to see if they would pull the plug on us....
Even if the patient is not terminally ill or permanently unconscious, it is not unethical to discontinue all means of life-sustaining medical treatment in accordance with a proper substituted judgment or best interests analysis.
(I hope the pings are not too burdensome (using Ohioan from Florida's ping list) some days there are none and other days several.
best interests analysis
Whose best interests? The fact that this is about ending someone's life, we know immediately that the best interests are not those of the patient. It's death for death's sake, with a possible financial benefit thrown in.
Thank you for the ping!
Thanks for the ping.
The surrogate doesn't even have to be someone close to the patient to order their death.
I have no trouble with anything here, in fact, it seems well thought out.
You have no problem with involuntary euthanasia? I'm shocked! Shocked I tells ya'.
I have no trouble with the process they've laid out for making medical decisions when the patient is unable to do so for themselves.
They're calling for euthanizing patients, without the consent of the patients. They're calling for denying or removing life support from patients who want life support. I have a real problem with that.
They're writing a policy on how to deal with hard cases where there is no hope for recovery and the patient can't speak for his/herself.
People need a way to make these decisions, and I have no trouble with the process they've laid out of looking to next of kin first, then the courts only if there is disagreement. That is what they should do.
But I know you, and I know you will not ever agree with me. So lets just ~not~ run around this tree all day eh? Your opposition is noted by me.
Even if the patient is not terminally ill or permanently unconscious, it is not unethical to discontinue all means of life-sustaining medical treatment in accordance with a proper substituted judgment or best interests analysis.
They are talking about removing life support from patients who are not permanently unconscious and not terminally ill without the consent of the patients, and in some cases without the consent of anyone close to the patients.
They're talking about the possibility that some cases may not fit a nice clean mold, and yet judgments may be made to not continue to treat some conditions. Therapies, surgeries and support may be appropriately judged to be futile.
You're both very welcome! Glad to be of service.
The past year or so there were conspiracy-theorist comments directed towards some of Terri's supporters. Those who had taken the time to research knew that there was a movement within the medical community to do just what they've said in this article is ethical in their eyes to do.
The of course there was the infamous quote by Jim King
"When all of us decided we were going to vote no, it wasn't to be disruptive. It wasn't even to be collegial, said Sen. Jim King, R-Jacksonville, the author of the state's death with dignity law. We did so because in our heart of hearts we thought it was the right thing to do for Terri and it was certainly the right thing for people who are like Terri."
There are also people in government who think some people should be left to die.
thought you'd be interested in this....
When you can't possibly know the 'wishes of the patient', decisions stil have to be made.
Good day... I'm at peace with this, whereas you will not be even if I talked myself blue in the face. Sorry about that.
True. You can't possibly convince me that involuntary euthanasia is a good policy. And btw, that's not an exception to their policy. Look again. It is their policy.
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