Ethics Committee Core Curriculum
End of Life Decisions
Catherine Lyons
Central to any decision about continuation of active treatment or
choosing a palliative care option is direct and honest communication of
prognosis and expected outcome to the patient and his family/significant
others. Despite advances in public education and promulgation of
patient-rights directed legislation such as the Patient Self Determination
Act, recent studies confirm "...substantial shortcomings in care for
seriously ill hospitalized patients. Enhancing opportunities for more
patient-physician communications, although advocated as the major method
for improving patient outcomes, may be inadequate to change established
practices. To improve experience of seriously ill and dying patients,
greater individual and societal commitment and more proactive and forceful
methods may be needed" (SUPPORT study, 1995).
The American public has great fears of the loss of personal
control at the end of life and as a result, an increasingly strong right
to die movement has taken place in the last decade. This section will
focus on three major end of life issues: Withdrawal of Active Treatment,
Assisted Suicide and Euthanasia. The following resources are useful
for background:
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Last Revised 2/15/97