Ethical Decisions in Terminal Illness

Abstract

Ethical decisions in terminal illness involve conflicts such as whether to withhold or to withdraw treatment, to perform a resuscitative attempt, or to allocate limited and expensive resources. Decision making has been complicated by the rapid progress in technology in intensive care and emergency medicine. A terminally ill patient is frequently unable to communicate and to express his or her will and preferences. Physicians often become a surrogate decision maker and have the responsibility of deciding whether to limit or withhold futile care. However, in terminal illness the definition of futility is not clear and is still a matter of discussion. Therefore, in the intensive and palliative care setting consensus among the diverse group of health care professionals is especially relevant. Despite a wide variety of personal beliefs and cultural and religious differences, decisions in ethical conflicts should be based on generally accepted principles such as respect for autonomy, beneficence, nonmaleficence, and justice.