Subject(s)
Ethics, Medical , Guidelines as Topic/standards , Gynecology/standards , Informed Consent/legislation & jurisprudence , Obstetrics/standards , Physician's Role , Female , Gynecology/legislation & jurisprudence , Humans , Obstetrics/legislation & jurisprudence , Patient Advocacy , Societies, Medical , Trust , United StatesSubject(s)
Health Care Rationing , Attitude to Health , Health Priorities , Methods , Public Opinion , United StatesABSTRACT
KIE: The author comments on the argument, for nonaggressive obstetric management of third trimester pregnancies with virtually untreatable anomalies, developed in the same journal issue by Frank Chervenak and Laurence McCullough, who base their argument on the ethical principles of autonomy and beneficence. While he views the argument for nonaggressive treatment from autonomy as less subject to internal contradiction, he stresses that beneficence can be used to argue for either aggressive or nonaggressive treatment based on varying values. The difficulty with Chervenak and McCullough's position arises because they identify nonaggressive treatment as beneficent and thereby imply that mothers who choose aggressive treatment violate that principle. Abrams argues that such a choice may rather indicate a different interpretation of beneficence so that only active intervention is morally acceptable.^ieng
Subject(s)
Beneficence , Congenital Abnormalities , Obstetrics/methods , Patient Selection , Pregnant Women , Value of Life , Withholding Treatment , Disclosure , Ethical Analysis , Ethics, Medical , Female , Humans , Infant, Newborn , Informed Consent , Personal Autonomy , Pregnancy , Risk Assessment , Social Values , Stress, PsychologicalABSTRACT
Withholding or withdrawing life-sustaining treatment when death is not imminent goes beyond the issue of whether or not medical interventions are simply prolonging dying. It treads on the slippery slope of quality of life judgments. Courts, in keeping with a tradition of self-determination, continue to protect a patient's right to decide whether his or her life has quality enough to prolong it. Patients may refuse treatment despite predictably dire consequences of refusal, including death. This choice is not evidence per se of incompetence, despite any conflict with medical values. Judicious use of technology is urged when there is conflict between the worthy principles of prolongation of life and relief of suffering. The patient is the best judge of his or her life's quality.
Subject(s)
Life Support Care/legislation & jurisprudence , Patient Advocacy/legislation & jurisprudence , Quality of Life , Withholding Treatment , Adult , Aged , Confidentiality , Female , Fluid Therapy , Humans , Male , Middle Aged , Parenteral Nutrition , Personal Autonomy , Suicide/legislation & jurisprudence , United States , Value of Life , Suicide PreventionABSTRACT
KIE: The "doctor knows best" standard of consent to care in England is held to be a possible early warning of changes to come in the United States as patient care is increasingly determined by economics and scarce resources. Political decisions not to pay for certain treatments or not to offer all technologies to all persons should not be disguised as medical decisions by not telling patients of possible therapies. Deception and failure to inform are violations of the physician's fiduciary relationship with the patient.^ieng
