Withholding Treatment

Publication Title: 
Health Progress (Saint Louis, Mo.)

The success of science and medical technology has led to medical brinkmanship, pushing aggressive treatment as far as it can go. But medicine lacks the precision necessary for such brinkmanship to succeed, and the resulting cycle of expectation and disappointment in technology has, in part, led to an increasing acceptance of euthanasia and assisted suicide, linked closely with advocacy for patient autonomy. At the opposite extreme lies medical vitalism, which refers to attempts to preserve the patient's life in and of itself without any significant hope for recovery.

Author(s): 
Nairn, T. A.
Publication Title: 
Christian Bioethics

The author comments on the consensus statement from the point of view of an ethics consultant in Germany. Since many hospitals in Germany are under considerable competitive pressure, mission statements are becoming more and more important in order to draw a distinction between the different hospital types and to convey the meaning of the corporate identity both internally and externally. The Consensus Statement, which provides basic orientation without going into too much detail, can be a helpful initial document.

Author(s): 
Schmidt, K. W.
Publication Title: 
Issues in Law & Medicine

On March 20, 2004, Pope John Paul II issued a statement to the International Conference on "Life Sustaining Treatments and Vegetative State: Scientific and Ethical Dilemmas" on the provision of food and water to patients in a "vegetative state." The purpose of this allocution was to promote and protect the dignity of patients, even when they are in a seriously ill and disabled state. To promote the dignity of these patients, the Pope explicitly stated that "quality of life judgments" were not to be applied to the administration of nutrition and fluids.

Author(s): 
Barry, Robert
Publication Title: 
Health care ethics USA: a publication of the Center for Health Care Ethics

Ethics committees are use [sic] to questions concerning the withdrawal of life-support. Such questions become increasingly complex when that life-support is implantable, like a pacemaker. This essay seeks to address the question of under what, if any, circumstances it would be permissible to discontinue the use of such implantable devices.

Author(s): 
Slosar, John Paul
Publication Title: 
Medicinska Etika a Bioetika: Casopis Ustavu Medicinskej Etiky a Bioetiky = Medical Ethics & Bioethics: Journal of the Institute of Medical Ethics & Bioethics

Decisions on whether to resuscitate severely premature infants are especially difficult in "borderline viability" cases--those where the probability of survival is slim, and where, if survival is possible, multiple co-morbidities and severe disabilities are likely. The 2000 International Guidelines on Cardiopulmonary Resuscitation are comprehensive, yet leave open some of the more difficult ethical questions that must be addressed by decision-makers.

Author(s): 
O'Brien, Dan
Publication Title: 
Medicinska Etika a Bioetika: Casopis Ustavu Medicinskej Etiky a Bioetiky = Medical Ethics & Bioethics: Journal of the Institute of Medical Ethics & Bioethics

We are all called to make moral decisions, not only about preserving life and health, but also about accepting our death and dying. There are situations, when it is morally right, and indeed obligatory, to allow a dying person to die in peace and dignity. But there is a world of difference between allowing a peaceful death, and deliberately setting out to bring death of the person either by acts of commission (s.c. 'active euthanasia'), or by acts of omission (s.c. 'passive euthanasia').

Author(s): 
Narbekovas, Andrius
Meilius, Kazimieras
Publication Title: 
Christian Bioethics

This article discusses the unexpectedly firm stance professed by John Paul II on the provision of artificial nutrition and hydration to patients who are in a persistent vegetative state, and it implications on previously held standards of judging medical treatments. The traditional ordinary/extraordinary care distinction is assessed in light of complexities of the recent allocution as well as its impact on Catholic individuals and in Catholic health care facilities.

Author(s): 
Shannon, Thomas A.
Publication Title: 
Christian Bioethics

This essay reviews the Roman Catholic moral tradition surrounding treatments at the end of life together with the challenges presented to that tradition by the Texas Advance Directives Act. The impact on Catholic health care facilities and physicians, and the way in which the moral tradition should be applied under this statute, particularly with reference to the provision dealing with conflicts over end-of-life treatments, will be critically assessed.

Author(s): 
Zientek, David M.
Publication Title: 
Christian Bioethics

A Christian analysis of the moral conflicts that exist among physicians and health care institutions requires a detailed treatment of the ethical issues in managed care. To be viable, managed care, as with any system of health care, must be economically sound and morally defensible. While managed care is per se a morally neutral concept, as it is currently practiced in the United States, it is morally dubious at best, and in many instances is antithetical to a Catholic Christian ethics of health care.

Author(s): 
Pellegrino, Edmund D.
Publication Title: 
The Journal of Clinical Ethics

How might clinicians best try to retain the trust of patients and family members after clinicians oppose giving a treatment? If clinicians can maintain the trust of patients and families in these situations, this may soften what may be the greatest possible loss--the death of a loved one. I discuss what clinicians seeking to retain trust should not do--namely impose their values and reason wrongly--and introduce strategies that clinicians may use to reduce both. I present five principles that clinicians can follow to try to retain trust, with examples that illustrate each.

Author(s): 
Howe, Edmund G.

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