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Citation |
Wilson ES, Pace N. Anaesthesia & Intensive Care Medicine 2004; 5(12): 414-417. |
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Copyright |
(Copyright © 2004, Elsevier Publishing) |
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DOI |
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PMID |
unavailable |
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Abstract |
The goal at the end of life is to provide quality care, respecting patient autonomy and offering opportunities for consent. Advance directives allow patients the opportunity to express treatment preferences in the event of their becoming incapacitated. While the law has a desire to support an individual's right to self-determination once incompetent, the broad non-specific nature of advance directives can make their application difficult. Do not resuscitate orders should be considered when the anticipated success rate is poor. It is essential to identify when cardiopulmonary arrest represents a terminal event. Adequate communication is essential. Brain death and organ donation raise many ethical issues. With respect to non-heart-beating organ donors, recent protocols have expanded their potential role to allow procurement of additional solid organs. Judgement decisions about whether or not to instigate a treatment are often based on the anticipated quality of life, which is linked to the concept of medical futility. This can be defined as treatment that cannot within a reasonable probability cure, ameliorate, improve or restore a quality of life that would be satisfactory to the patient. In turn, while healthcare resources must be fairly distributed, treatment decisions based on solely financial reasons must be avoided. Withholding or withdrawing treatment that hastens natural death, is permissible, provided the intention is not to kill the patient. However, the distinctions between voluntary passive euthanasia, physician-assisted suicide and active euthanasia are fraught with legal and moral difficulties. It is also acceptable to administer certain treatments that may have both a beneficial and a harmful effect, provided the intention is to provide the beneficial effect. © 2004 Elsevier Ltd. All rights reserved. Language: en |
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Keywords |
resuscitation; quality of life; ethics; intensive care; autonomy; advance directive; futility; withholding treatment |