Changing attitudes and practices in foregoing life-sustaining treatments

Abstract

Advances in medical technology and practices have been associated with improved patient outcomes. At times, the price of this progress has included great financial costs and human suffering. During the last two decades, there have been significant changes in medical practices in America. In the late 1960s and early 1970s, the removal of a respirator or hydration or nutrition from a patient who was not brain dead was considered a deviation from accepted medical practices. In 1976, the Quinlan case allowed the removal of a ventilator from a patient in a persistent vegetative state. Subsequent court decisions in the 1980s have equated hydration and artificial feeding with other forms of life-sustaining treatments and have allowed their withdrawal in patients who were not terminally ill. Prominent physicians have recently stated that it is not immoral for a physician to assist in the rational suicide of a terminally ill patient. Active euthanasia programs in the United States are likely in the near future.

KIE: Sprung reviews the changes in medical practice and attitudes over the past two decades toward the care of patients who are dying, in a persistent vegetative state, or who refuse life-sustaining treatment. He is concerned also with court decisions that equate artificial feeding and intravenous fluids with medical procedures that may be administered or withheld according to the benefits and burdens to the patient. Sprung believes that these practical, attitudinal, and legal changes eventually will lead to the acceptance of active euthanasia in the United States. He concludes his essay with references to the role physicians played in direct medical killing and genocide in Nazi Germany.