Prolonging Life, Not Death
The American Medical Assn. has made a wise and useful revision of its code of ethics to permit medical doctors to withhold from certain patients “all means of life-prolonging medical treatment,” including food and water.
Decisions must respect the commitment of the medical profession to sustain life and to relieve suffering, according to the new statement of the AMA’s Council on Ethical and Judicial Affairs. When those commitments conflict, the wishes of the patient must prevail as the physician weighs withholding or withdrawing life-prolonging medical treatment. When the patient is not competent, the family of the patient or a legal representative can help make the decision.
There will inevitably be a balancing of issues, the statement notes. The doctor must not intentionally cause death, but, when death is imminent, must assure the humane and comfortable condition of the patient.
The most immediate effect of the new statement will be in cases where death is not imminent but the patient is in an irreversible coma. In these circumstances, the council has found, it is “not unethical” for the physician to terminate all treatment--including medication, artificial respiration, food and water.
A case now in litigation in Massachusetts has dramatized the problem. Doctors there have resisted the pleas of the family to terminate food and water for a patient who has been comatose for more than two years with no prospect of recovering consciousness. There are an estimated 10,000 persons in this comatose state in the nation.
The explicit identification of food and water as a life-prolonging treatment that may be withheld in certain circumstances follows a similar conclusion last year by the Joint Committee on Biomedical Ethics of the Los Angeles County Bar and Medical associations.
“At all times the dignity of the patient should be maintained,” the AMA council concluded.
This statement will facilitate the protection of that dignity and encourage a wiser use of ever-improving technologies, assuring that they are applied to sustain life, not prolong death.
