For four decades, medical professionals and policy makers have looked to bioethicists for advice in shaping medical guidelines and laws on end-of-life care. Because of its profundity, end-of-life decision-making occupies center stage in contemporary American bioethics. Or, they may hasten death by forgoing treatment or by seeking to take action to bring life to an end. They may forestall death by choosing heroic measures to sustain life, such as resuscitation. Once it was common to speak of nature taking its course, but today it is more common to view death as a matter about which people-individuals at or near death, or their surrogates-have some control. While the fact of death remains inevitable, its timing is often very much a function of human agency. For the nearly 80 percent of those who live their final days in hospitals, nursing homes, and at home in hospice care, decisions continually need to be made about what treatment to administer, what treatment to cease or withhold, what treatment to continue, and what treatment to taper off. Approximately 2.5 million Americans die each year in the United States. In reality, however, these decisions are omnipresent, and far more mundane than the headlines suggest. When the news fades, often so does public attention to end-of-life decisions. The Schiavo case in 2005 was the most recent episode, but before that it was the Cruzan case in 1990 and the Quinlan case in 1976. Another challenge to long-held ethical views on end-of-life care is coming from new findings in neuroscience-specifically, evidence that a “permanent vegetative state” may not always be permanent, suggesting that treatment in such circumstances may sometimes not be futile.Įnd-of-life care and its many dilemmas capture public attention when they make national news, often involving a family seeking a court order to remove life support from a patient who, medical experts say, is in a vegetative state with no hope of recovery.Some bioethicists now believe that other interests should be considered in end-of-life decision-making, such as the wishes of family members and others who are close to the patient.Patients can express their wishes for end-of-life care in advance directives such as living wills, which are legally binding in all 50 states.Traditionally, ethicists have considered patients’ wishes to be paramount.Bioethics has long shaped policy concerning end-of-life decision-making, which involves numerous choices about what treatments to administer, taper off, cease, or withhold.Torture: The Bioethics Perspective Steven H.Research in Resource-Poor Countries Voo Teck Chuan, G.Quality Improvement Methods in Health Care Mary Ann Baily.
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