On deciding the care of severely handicapped or dying persons: with particular reference to infants

Abstract

Two philosophies of deciding the care of severely handicapped or dying persons are commonly used. The first is "disease-oriented" which places death in the extreme negative position. The second is "person-oriented" which regards some kinds of severely compromised living as worse than death. The first philosophy is convenient for the development and the use of medical technology but its unbridled application commonly dehumanizes patients and aggravates suffering. The second philosophy may protect persons from the indignities of pointless treatment or the cruelties of disease. But its use in some respects is illegal and may be unwise; also, in caring for infants, children, and incompetent adults, the second philosophy creates special problems since the patient himself cannot participate in decision-making. In deciding which philosophy to follow in a given situation we believe the patient (when able), the sorrowing family, and the concerned physician are the best judges. Since these persons vary widely, they must be entrusted with more freedom to change or to ignore commonly accepted principles if the values of patients and families in the many unique situations of living, illness, and dying are to be protected. We believe with few exceptions that these persons are now worthy of this trust and with experience they would use it with growing wisdom.