Advertisement

Ethics and the End-of-Life Care

  • Dan R. Thompson

Abstract

The basis for much of what we find to be ethics rests in theory and principles. Although the terms ethics and morality represent the same concept and therefore are interchangeable, we generally use the term ethics. Bioethics is the common term for ethics in the biosciences, which includes medicine. The term morality seems to have a religious overtone. We will examine the concepts from a Western perspective, but ethical principles should truly be considered universal and not dependent on location. Although this might not necessarily be true, discussion of that issue is beyond the scope of this chapter. The study of bioethics is based on four simple concepts – autonomy, beneficence, justice, and nonmaleficence – that we will review briefly.1,2

Keywords

Brain Death Distributive Justice Advance Directive Health Care Team Critical Care Unit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Thompson DR, Kummer HB, editors. Critical care ethics: a practice guide from the ACCM Ethics Committee. Chicago: Society of Critical Care Medicine; 2005.Google Scholar
  2. 2.
    Thompson D. Principles in the ethics in managing a critical care unit. Crit Care Med. 2007;35(2 Suppl):S2–S10.PubMedCrossRefGoogle Scholar
  3. 3.
    Munson R. Part V: foundations of bioethics: ethical theories, moral principles and medical decisions. intervention and reflection, basic issues in medical ethics. 7th ed. Belmont: Wadsworth/Thompson Learning; 2004.Google Scholar
  4. 4.
    Beauchamp T, Childress J. Principles of biomedical ethics. 5th ed. New York: Oxford University Press; 2001.Google Scholar
  5. 5.
    Suggs MJ, Sakenfeld KD, Mueller JR, editors. The Oxford Study Bible: Revised English Bible with Apocrypha. New York: Oxford University Press; 1992. No. Gospel of Luke, Chapter 10.Google Scholar
  6. 6.
    Jonsen AR, Siegler M, Winslade WJ. Clinical ethics: a practical approach to ethical decisions in clinical medicine. New York: McGraw-Hill Medical; 2002.Google Scholar
  7. 7.
    Thompson D, Thompson D. Ethics Committees. In: Crippen D, editor. End of life communications in the ICU: a global perspective. New York: Springer; 2008.Google Scholar
  8. 8.
    Ravitsky V. Timers on ventilators. BMJ. 2005;330:415–417.PubMedCrossRefGoogle Scholar
  9. 9.
    Kelly G. The duty to preserve life. Theol Stud. 1951;12:550.Google Scholar
  10. 10.
    Grisso T, Appelbaum PS. Assessing competence of consent to treatment. New York: Oxford University Press; 1998.Google Scholar
  11. 11.
    Dubler NN, Liebman CB. Bioethics mediation: a guide to shaping shared solutions. New York: United Hospital Fund of New York; 2004.Google Scholar
  12. 12.
    Ganzini L, Goy E, Miller L, Harvath T, Jackson A, Delorit M. Nurses’ experiences with hospice patients who refuse food and fluids to hasten death. N Engl J Med. 2003;349(24):359–365.PubMedCrossRefGoogle Scholar
  13. 13.
    Ganzini L. Artificial nutrition and hydration at the end of life: ethics and evidence. Palliat Support Care. 2006;4(2):135–143.PubMedCrossRefGoogle Scholar
  14. 14.
    Muramoto O. Bioethical aspects of the recent changes in the policy of refusal of blood by Jehovah’s Witnesses. BMJ. 2001;322:37–39.PubMedCrossRefGoogle Scholar
  15. 15.
    Luce J, Prendergast T. The changing nature of death in the ICU. In: Curtis J, Rubenfeld G, editors. Managing death in the intensive care unit: the transition from cure to comfort. New York: Oxford University Press; 2001. p. 19–29.Google Scholar
  16. 16.
    Finucane T. How gravely ill becomes dying: a key to end-of-life care. JAMA. 1999;282(17):1670–1672.PubMedCrossRefGoogle Scholar
  17. 17.
    Truog RD, Campbell ML, Curtis JR, et al. Recommendations for end-of-life care in the intensive care unit. Crit Care Med. 2001;29(12):2332–2348.PubMedCrossRefGoogle Scholar
  18. 18.
    Nuremberg Code: Directives for Human Experimentation. Washington, DC. Available at: http://ohsr.od.nih.gov/guidelines/nuremberg.html. Accessed Dec 21, 2007.
  19. 19.
    Williams P, Wallace D. Unit 731: Japan’s Secret Biological Warfare in World War II. New York: Free Press; 1989.Google Scholar
  20. 20.
    Beecher H. Ethics and clinical research. N Engl J Med. 1966;274:1354–1360.PubMedCrossRefGoogle Scholar
  21. 21.
    Pappworth M. Human guinea pigs. Boston: Beacon Press; 1967.Google Scholar
  22. 22.
    The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Principles and Guidelines for the protection of human subjects of research. Department of Health, Education, and Welfare. Available at: http://ohsr.od.nih.gov/guidelines/belmont.html. Accessed Dec 21, 2007.
  23. 23.
    The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301–1308.CrossRefGoogle Scholar
  24. 24.
    A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to examine the definition of brain death. JAMA 1968;205:337.Google Scholar
  25. 25.
    Baron L, Shemie S, Teitelbaum J, Doig C. Brief review: history, concept and controversies in the neurological determination of death. Can J Anesth. 2006;53(6):602–608.PubMedCrossRefGoogle Scholar
  26. 26.
    Lang CJG, Heckmann J. Apnea testing for the diagnosis of brain death. Acta Neurol Scand. 2005;112(6):358–369.PubMedCrossRefGoogle Scholar
  27. 27.
    Task Force on Brain Death in Children. Guidelines for the determination of brain death in children. Pediatrics 1987;80:298–299.Google Scholar
  28. 28.
    Bleich J. Time of death in Jewish law. New York: Z. Berman Publishing Co; 1991.Google Scholar
  29. 29.
  30. 30.
    The Ethics Committee American College of Critical Care Medicine and Society of Critical Care Medicine. Recommendations for non heart beating organ donation: position paper. Crit Care Med 2001;29:1826–1831.Google Scholar
  31. 31.
    Strosberg MA, Teres D. Gatekeeping in the intensive care unit. Chicago: Health Administration Press; 1997.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Dan R. Thompson
    • 1
  1. 1.Professor of Surgery and Anesthesiology, Department of Surgery, Alden March Bioethics InstituteAlbany Medical CollegeAlbanyUSA

Personalised recommendations