Termination of Life-Support Without Patient Request
To clarify my views on life-support described in the last posting, I want to note the situation that I didn’t really include. I wrote that it is my view (and it is the consensus in law and ethics) that a patient with capacity for medical decision-making can request and must be granted termination of life-support. To continue the support against the patient’s wishes could be considered legal battery. What I didn’t write was whether, without the permission of the patient or surrogate, life-support could be removed based on the argument of medical futility. The answer should be no if the life-support is physiologically effective and the patient finds that the current or future quality of life satisfactory since there would exist no futility issue. In an unresolved conflict between physician and patient, the courts must decide. The problem arises when the patient has no capacity to make medical decisions and there is no advance directive, no previous expression of goals and no surrogates. Life-support could be removed from such a patient on the basis that the treatment would not be expected to produce recovery to a state that a “reasonable person” might expect and a hospital ethics committee that included community members confirmed the decision of the physician to terminate treatment. The ethics of this issue is all that simple!?? Any questions? ..Maurice.