Ethics Commission examines moral distinctions in using life supports.

Abstract

Deciding to Forego Life-Sustaining Treatment, a report of the President's Commission for the study of Ethical Problems in Medicine and Biomedical and Behavioral Research, examines four common medical-ethical distinctions. The report highlights the 1980 Declaration on Euthanasia and closely follows Catholic moral teaching on the following. Death by action versus omitting to act. The commission rejects the idea that a physician who fails to act should not be held responsible for a patient's death. Failing to resuscitate, for example, or to take other steps to prolong life, are just as much causes of death as a lethal injection. The health profession's traditional duty to act on the patient's behalf precludes any distinction between acts and omissions. Withdrawing versus withholding treatment. Acknowledging that initiating treatment may create an obligation to continue treatment, the commission suggests that distinguishing between withholding and withdrawing could encourage undertreatment and overtreatment. Fear of being unable to withdraw unsuccessful treatment could lead to physicians' failing to treat patients who might benefit from the therapy. Ordinary versus extraordinary means. The commission upholds this distinction. It suggests, however, that the phrase "proportionate versus disproportionate" better describes the moral issue involved in selecting treatments that, in relation to their expected benefits, impose no excessive burden on the patient or family. Regarding intended versus unintended consequences, the commission departs from Catholic tradition. It fails to acknowledge the significance of physicians' intentions. What matters instead, according to the commission, is whether physicians act within their authority as defined by society. Thus, the commission suggests, the use of pain medications that may cause death can be socially and legally acceptable.