Abstract
The implementation of a living will can give rise to ethical dilemmas for the patient's family and the health care professionals involved. The case reported here raises questions about the right of patients to self-determination, the importance of quality-of-life considerations in treatment decisions and physicians' obligations with respect to the implementation of living wills. Physicians should ensure in advance that the instructions set out in a living will are unambiguous and should bring to the patient's attention any ethical difficulties that they foresee in carrying out those instructions.
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Selected References
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- Brody H. Withdrawing versus withholding therapy: still a pernicious distinction. J Am Geriatr Soc. 1995 Jun;43(6):716–717. doi: 10.1111/j.1532-5415.1995.tb07214.x. [DOI] [PubMed] [Google Scholar]
- Danis M., Southerland L. I., Garrett J. M., Smith J. L., Hielema F., Pickard C. G., Egner D. M., Patrick D. L. A prospective study of advance directives for life-sustaining care. N Engl J Med. 1991 Mar 28;324(13):882–888. doi: 10.1056/NEJM199103283241304. [DOI] [PubMed] [Google Scholar]
- Davidson K. W., Hackler C., Caradine D. R., McCord R. S. Physicians' attitudes on advance directives. JAMA. 1989 Nov 3;262(17):2415–2419. [PubMed] [Google Scholar]
- Edwards M. J., Tolle S. W. Disconnecting a ventilator at the request of a patient who knows he will then die: the doctor's anguish. Ann Intern Med. 1992 Aug 1;117(3):254–256. doi: 10.7326/0003-4819-117-3-254. [DOI] [PubMed] [Google Scholar]
- Ellard J. Medical ethics--fact or fiction? Med J Aust. 1993 Apr 5;158(7):460–464. [PubMed] [Google Scholar]
- Emanuel L. L., Emanuel E. J., Stoeckle J. D., Hummel L. R., Barry M. J. Advance directives. Stability of patients' treatment choices. Arch Intern Med. 1994 Jan 24;154(2):209–217. doi: 10.1001/archinte.154.2.209. [DOI] [PubMed] [Google Scholar]
- Fried T. R., Gillick M. R. Medical decision-making in the last six months of life: choices about limitation of care. J Am Geriatr Soc. 1994 Mar;42(3):303–307. doi: 10.1111/j.1532-5415.1994.tb01756.x. [DOI] [PubMed] [Google Scholar]
- Hughes D. L., Singer P. A. Family physicians' attitudes toward advance directives. CMAJ. 1992 Jun 1;146(11):1937–1944. [PMC free article] [PubMed] [Google Scholar]
- Jecker N. S., Emanuel L. Are acting and omitting morally equivalent? A reappraisal. J Am Geriatr Soc. 1995 Jun;43(6):696–701. doi: 10.1111/j.1532-5415.1995.tb07209.x. [DOI] [PubMed] [Google Scholar]
- Jennett B., Plum F. Persistent vegetative state after brain damage. A syndrome in search of a name. Lancet. 1972 Apr 1;1(7753):734–737. doi: 10.1016/s0140-6736(72)90242-5. [DOI] [PubMed] [Google Scholar]
- Korgaonkar G., Tribe D. Doctors, 'living wills' and the law. 1993 Apr 21-May 4Br J Hosp Med. 49(8):576–578. [PubMed] [Google Scholar]
- Pellegrino E. D. Nonabandonment: an old obligation revisited. Ann Intern Med. 1995 Mar 1;122(5):377–378. doi: 10.7326/0003-4819-122-5-199503010-00010. [DOI] [PubMed] [Google Scholar]
- Quill T. E., Cassel C. K. Nonabandonment: a central obligation for physicians. Ann Intern Med. 1995 Mar 1;122(5):368–374. doi: 10.7326/0003-4819-122-5-199503010-00008. [DOI] [PubMed] [Google Scholar]
- Reilly R. B., Teasdale T. A., McCullough L. B. Projecting patients' preferences from living wills: an invalid strategy for management of dementia with life-threatening illness. J Am Geriatr Soc. 1994 Sep;42(9):997–1003. doi: 10.1111/j.1532-5415.1994.tb06595.x. [DOI] [PubMed] [Google Scholar]
- Schneiderman L. J., Teetzel H. Who decides who decides? When disagreement occurs between the physician and the patient's appointed proxy about the patient's decision-making capacity. Arch Intern Med. 1995 Apr 24;155(8):793–796. doi: 10.1001/archinte.155.8.793. [DOI] [PubMed] [Google Scholar]
- Silberfeld M., Madigan K. V., Dickens B. M. Liability concerns about the implementation of advance directives. CMAJ. 1994 Aug 1;151(3):285–289. [PMC free article] [PubMed] [Google Scholar]
- Weir R. F., Gostin L. Decisions to abate life-sustaining treatment for nonautonomous patients. Ethical standards and legal liability for physicians after Cruzan. JAMA. 1990 Oct 10;264(14):1846–1853. [PubMed] [Google Scholar]
