AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. December 2013, Volume 15, Number 12.

Ethics Poll

End-of-Life Care

The Ethics Poll is a snapshot of the opinions of interested readers.

In its 1990 decision in the Cruzan case, the U.S. Supreme Court ruled that artificial nutrition and hydration are no different from any other medical intervention, and therefore can be withdrawn from a patient who wishes (or whose surrogate wishes) that life-sustaining treatment be discontinued. The court's position is not accepted by all; many religious authorities, for example, think that withdrawing nutrition and hydration is actively starving the patient, rather than allowing the patient to die from his or her illness. Which of the following best expresses your thinking on the question of withdrawing nutrition and hydration?
It is like any other medical intervention; therefore it can be withdrawn to allow the patient to die from his or her illness.
It is not like any other medical intervention, therefore it should be continued until the patient dies from his or her illness.
It doesn't matter whether it is like any other medical intervention or not, if the patient or surrogate doesn't want it continued, it should be discontinued.
Don’t know.

When physicians prognosticate that a patient has 6 months or less to live, that patient is eligible for hospice care. Yet surveys show that more than 50 percent of patients who spend time in hospice care spend 14 or fewer days. Do you think that it would be better if patients who are expected to die within 6 months spent more than an average 14 days in hospice care?
Yes, because they would have better symptom control and be more comfortable.
Yes, because it is easier on their family members or other caregivers when the patient is receiving hospice care.
No, because once patients accept that they are actively dying, they lose hope, which is more difficult for them and their family members to handle.
Don’t know.

Do you have an advance directive designating a surrogate decisionmaker or stating what sort of care you wish to receive should you become unable to communicate with caregivers?
Yes.
No.
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