Virtual Mentor. January 2005, Volume 7, Number 1.
Case 5.3: Withdrawing or Withholding Treatment—Respecting Patients' End-of-Life Decisions
The principle of patient autonomy requires that physicians respect a competent patient's decision to forgo any medical treatment. This principle is not altered when the likely result of withholding or withdrawing a treatment is hastening the patient's death.
Decisions to forgo life-sustaining treatment, which so profoundly affect a patient's well-being, cannot be made independent of a patient's subjective preferences and values. Many types of life-sustaining treatments are burdensome and invasive, so that the choice for the patient is not simply a choice between life and death. When a patient is dying of cancer, for example, a decision may have to be made whether to use a regimen of chemotherapy that might prolong life for several additional months but also would be painful and debilitating. Patients, however, are no longer required to choose between aggressive life-sustaining or life-prolonging treatment and no treatment; medical professionals are becoming increasingly aware of the value of palliative care.
There is no ethical distinction between withdrawing and withholding life-sustaining treatment. A patient's right to refuse treatment is independent of whether treatment has begun.
In summary, according to the principle of respect for patient autonomy, patients who possess decision-making capacity have the right to forgo any life-sustaining treatment. Physicians must respect these patient decisions, and they must ensure that patients are well-informed about their prognoses and treatment options and understand that comfort and dignity will be top priorities whether or not they decide to forgo life support.
The people and events in this case are fictional. Resemblance to real events or to names of people, living or dead, is entirely coincidental. The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.
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