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Problems in the Care of the Terminally Ill

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Textbook of Healthcare Ethics
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Summary

In summary, there are certain critical considerations this chapter has tried to sketch. Among these are cultural and historical differences in thinking about death and the stage of dying; the difference between life as a biological and life as a cognitive, self-realizing, and self-actualizing state and the ethical implications such considerations may have; various forms of acognitive states; problems of limiting therapy and of artificial feeding; suicide and euthanasia; and problems of futility. Central to all of these issues is the issue of orchestrating death and in so doing communicating with patients and with their families. Healthcare professionals-no matter what their role or area of practice-should seek to have an ongoing dialogue with their patients and with their patients’ families. If they do this, if they share their fallibility, their humanity, and their agony with the patient and with their patient’s families (instead of acting like remote gods), many of these issues will be much easier to deal with than they often are today.

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References

  1. Rachels J. The End of Life. New York, NY: Oxford University Press, 1986.

    Google Scholar 

  2. Kushner T. Having a life versus being alive. J Med Ethics. 1984;1:5–8.

    Google Scholar 

  3. Aries P. L’Homme Devant la Mort. Paris; Edition du Seuil, 1977.

    Google Scholar 

  4. Lattimore R (trans). The Odyssey of Homer. New York, NY: Harper & Row, 1967.

    Google Scholar 

  5. Carrick P. Medical Ethics in Antiquity. Dordrecht, Netherlands: D. Reidel, 1985.

    Google Scholar 

  6. Plato; Rouse WH, trans. In: Warmington EH, Rouse PS, eds. Great Dialogues of Plato. New York, NY: American Library, 1956;460–521.

    Google Scholar 

  7. Cullman O. Immortality of the soul or resurrection of the dead. In: Stendhal K, ed. Immortality and Resurrection. New York, NY: Macmillan, 1965; 132–164.

    Google Scholar 

  8. KĂĽbler-Ross E, On Death and Dying. New York, NY: Macmillan, 1969.

    Google Scholar 

  9. Churchill LR. Interpretation of dying: ethical implications for patient care. Ethics Sci Med. 1979;6(4):211–222.

    PubMed  CAS  Google Scholar 

  10. Pearlman R, Speer J Jr. Quality of life considerations in geriatric care. J Am Geriatr Soc. 1983;31(2):113–130.

    PubMed  CAS  Google Scholar 

  11. Pellegrino ED, Thomasma DC. For the Patient’s Good: The Restoration of Beneficence in Health Care. New York, NY: Oxford University Press, 1988.

    Google Scholar 

  12. Blackhall LJ. Must we always use CPR? N Eng J Med. 1987;20:1281–1284.

    Google Scholar 

  13. Amundsen DW. The physician’s obligation to prolong life: a medical duty without classical roots. Hastings Center Report. 1978;8(4):23–31.

    PubMed  CAS  Google Scholar 

  14. Pariser JJ. Comfort measures only for DNR orders. Conn Med. 1982;46(4): 23–31.

    Google Scholar 

  15. Loewy EH. Patient, family, physician: agreement, disagreement, and resolution. Family Med. 1986;18(6):375–378.

    CAS  Google Scholar 

  16. Meisel A. Legal myths about terminating life support. Arch Intern Med. 1991; 151:1497–1501.

    Article  PubMed  CAS  Google Scholar 

  17. Bedell SE, Delbanco TL, Cook EF, et al. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med. 1983;309:569–576.

    Article  PubMed  CAS  Google Scholar 

  18. Stollerman GH. Decisions to leave home. J Am Geriatr Soc. 1988;36:375–376.

    PubMed  CAS  Google Scholar 

  19. Loewy EH. Decisions not to leave home: and what will the neighbors say? J Am Geriatr Soc. 1988;36:1143–1146.

    PubMed  CAS  Google Scholar 

  20. Rossman I. The geriatrician and the homebound patient. J Am Geriatr Soc. 1988;36:348–354.

    PubMed  CAS  Google Scholar 

  21. Stollerman GH. Lovable decisions: re-humanizing dying. J Am Geriatr Soc. 1986;34:172.

    PubMed  CAS  Google Scholar 

  22. Hilfiker D. Allowing the debilitated to die: facing our ethical choices. N Engl J Med. 1983;308:716–719.

    Article  PubMed  CAS  Google Scholar 

  23. Loewy EH. Treatment decisions in the mentally impaired: limiting but not abandoning treatment. N Engl J Med. 1987;317:1465–1469.

    Article  PubMed  CAS  Google Scholar 

  24. Daugherty JH, Rawlinson DG, Levy DE, et al. Hypoxic-ischemic brain injury and the vegetative state: clinical and neuropathological correlation. Neurology 1981;31:991–997.

    Google Scholar 

  25. Plum F, Posner J. The Diagnosis of Stupor and Coma, 3rd ed. Philadelphia, Pa: F.A. Davis, 1983.

    Google Scholar 

  26. Plum F, Posner JB. Disturbances of consciousness and arousal. In: Wyngaarden JB, Smith JB, eds. Cecil’s Textbook of Medicine, 20th ed. Philadelphia, Pa: W.B. Saunders, 1993;2061–2076.

    Google Scholar 

  27. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Deciding to Forego Life-Sustaining Treatment. Washington, DC: U.S. Government Printing Office, 1982.

    Google Scholar 

  28. Jonas H. Das Prinzip Verantwortung; and Jonas H. Technik, Medizin und Ethik. Frankfurt: Suhrkamp, 1987.

    Google Scholar 

  29. Jonas H. Against the stream. In: Jonas H, ed. Philosophical Essays: From Ancient Creed to Technological Man. Englewood Cliffs, NJ: Prentice Hall, 1974.

    Google Scholar 

  30. Jonas H. The right to die. Hastings Center Report. 1978;8(4):31–36.

    PubMed  CAS  Google Scholar 

  31. Ramsey P. The Patient as Person. New Haven, Conn: Yale University Press, 1970.

    Google Scholar 

  32. Capron AM. Ironics and tensions in feeding the dying. Hastings Center Report. 1984;14(5):32–35. Also see footnote 38. Towers B. Irreversible coma and withdrawal of life support: is it murder if the IV line is disconnected? JMed Ethics. 1982;8(4):203–205.

    PubMed  CAS  Google Scholar 

  33. Meilander G. Removing food and water: against the stream. Hastings Center Report. 1984;14(6):11–13.

    Google Scholar 

  34. Callahan D. On feeding the dying. Hastings Center Report. 1984;14(6):22.

    Google Scholar 

  35. Derr PG. Why food and fluids can never be denied. Hastings Center. 1984; 16(1):28–30. Also see footnote 36. Lynn J, Childress JF. Must patients always be given food and water? Hastings Center Report. 1983;13(5):17–21.

    Google Scholar 

  36. Lynn J, Childress JF. Must patients always be given food and water? Hastings Center Report. 1983;13(5):17–21.

    PubMed  CAS  Google Scholar 

  37. Wanzer SH, Adelstein SJ, Cranford RE. The physician’s responsibility toward hopelessly ill patients. N Engl J Med. 1984;310(15):955–959.

    Article  PubMed  CAS  Google Scholar 

  38. Towers B. Irreversible coma and withdrawal of life support: is it murder if the IV line is disconnected? J Med Ethics. 1982;8(4):203–205.

    Article  PubMed  CAS  Google Scholar 

  39. Steinbock B. The removal of Mr. Herbert’s feeding tube. Hastings Center Report 1983;13(5):13–16.

    PubMed  CAS  Google Scholar 

  40. Green W. Setting boundaries for artificial feeding. Hastings Center Report. 1984;14(6):8–10.

    PubMed  CAS  Google Scholar 

  41. Annas GJ. Do feeding tubes have more rights than patients? Hastings Center Report. 1986;16(1):26–28.

    Google Scholar 

  42. Paris JJ. When burdens of feeding outweigh benefits. Hastings Center Report. 1986;16(1):30–32.

    PubMed  CAS  Google Scholar 

  43. Loewy EH. Healing and killing, harming and not harming: physician participation in euthanasia and capital punishment. J Clin Ethics. 1992;3(1):29–34.

    PubMed  CAS  Google Scholar 

  44. Amundsen DW. History of medical ethics: ancient Near-East. In: Reich WT, ed. Encyclopedia of Bioethics. New York, NY: Macmillan, 1978.

    Google Scholar 

  45. Gourevitch D. Suicide among the sick in classical antiquity. Bull Hist Med. 1969;43:501–508.

    PubMed  CAS  Google Scholar 

  46. Pius XII. The prolongation of life. Pope Speaks. 1958;4(4):393–398.

    Google Scholar 

  47. Trammel R. Saving life and taking life. J Phil. 1975;72:131–137.

    Article  Google Scholar 

  48. Rachels J. Active and passive euthanasia. N Engl J Med. 1975;292(2):78–80.

    Article  PubMed  CAS  Google Scholar 

  49. Gaylin W, Kass LR, Pellegrino ED, et al. Doctors must not kill. JAMA. 1988; 259:2139–2140.

    Article  PubMed  CAS  Google Scholar 

  50. Stuart FP, Veith FJ, Cranford RE. Brain death laws and patterns of consent to remove organs for transplantation from cadavers in the United States and 28 other countries. Transplant. 1981;31(4):238–244.

    CAS  Google Scholar 

  51. Cassel E. The Healer’s Art: A New Approach to the Physician-Patient Relationship. Philadelphia, Pa: J.B. Lippincott, 1976.

    Google Scholar 

  52. Lo B, Saika G, Strull W, et al. “Do not resuscitate” decisions: a prospective study at three teaching hospitals. Arch Intern Med. 1985;145(6):1115–1117.

    Article  PubMed  CAS  Google Scholar 

  53. Youngner SJ, Lewandowski W, McClish DK, et al. “Do not resuscitate” orders: incidence and implications in a medical intensive care unit. JAMA. 1985; 253:154–157.

    Article  Google Scholar 

  54. Freedman B. Offering truth. Arch Intern Med. 1993;153:572–576.

    Article  PubMed  CAS  Google Scholar 

  55. Cassel E. The function of medicine. Hastings Center Report. 1977;7(6):16–19.

    Google Scholar 

  56. Good MD. The practice of biomedicine and the discourse on hope. Anthropol Med. 1991;7:121–135; and Pellegrino ED. Is truth telling to patients a cultural artifact? JAMA. 1992;268( 13):1734–1735.

    Google Scholar 

  57. Hardin G. The tragedy of the commons. Science. 1968;162:1243–1248.

    CAS  Google Scholar 

  58. Hiatt HHL. Protecting the medical commons: Who is responsible? N Engl J Med. 1975;293(5):235–241.

    Article  PubMed  CAS  Google Scholar 

  59. Schneiderman LJ, Jecker NS, Jonsen AR. Medical futility: its meaning and ethical implications. Ann Int Med. 1990;1112:949–954.

    Google Scholar 

  60. Jecker NS. Knowing when to stop: the limits of medicine. Hastings Center Report. 1991;19(2):235–241.

    Google Scholar 

  61. Schneiderman LJ, Jecker N. Futility in practice. Arch Int Med. 1993;153: 437–441.

    Article  CAS  Google Scholar 

  62. Loewy EH, Carlson RA. Futility and its wider implications: a concept in need of further examination. Arch Intern Med. 1993;153:429–431.

    Article  PubMed  CAS  Google Scholar 

  63. Loewy EH. Futility and the goals of medicine. Eur Philos Med Health Care. 1993;1(2):15–29.

    Google Scholar 

  64. Nelson W, Nelson RM. Ethics and the provision of futile, harmful or burdensome treatment to children. Crit Cure Med. 1992;20(3):427–433.

    CAS  Google Scholar 

  65. Hastings Center. Guidelines on the Termination of Therapy and the Care of the Dying. Briarcliff Manor, NY: Hastings Center, 1987.

    Google Scholar 

  66. Jecker NS, Schneiderman LJ. Futility and rationing. Am J Med. 1992;92: 189–196.

    Article  PubMed  CAS  Google Scholar 

  67. Knaus W. Ethical implications of risk stratification in the acute care setting. Cambr Q Health Cure Ethics. 1993;2(2):193–196.

    CAS  Google Scholar 

  68. Balakrishnan G, Aitchison T, Hallworth D, Morton NS. Prospective evaluation of the Paediatric Risk of Mortality (PRIZM) score. Arch Dis Child. 1992;67(2):196–200.

    Article  PubMed  CAS  Google Scholar 

  69. Hackler JC, Hiller FC. Family consent to orders not to resuscitate. JAMA. 1990;264(1):1281–1283.

    Article  PubMed  CAS  Google Scholar 

  70. Faber-Langendoen K. Resuscitation of patients with metastatic cancer. Arch Intern Med. 1991;151:235–239.

    Article  PubMed  CAS  Google Scholar 

  71. Gray WA, Capone RJ, Most AS. Unsuccessful emergency medical resuscitation—are continued efforts in the emergency department justified? N Engl J Med. 1991;325:1393–1398.

    PubMed  CAS  Google Scholar 

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© 2002 Kluwer Academic Publishers

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(2002). Problems in the Care of the Terminally Ill. In: Textbook of Healthcare Ethics. Springer, Dordrecht. https://doi.org/10.1007/0-306-46801-8_9

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  • DOI: https://doi.org/10.1007/0-306-46801-8_9

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-0-306-45240-6

  • Online ISBN: 978-0-306-46801-8

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