Abstract: A comprehensive report by the US President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research addresses some of the most important and troubling ethical and legal questions in modern medicine for consideration by health care professionals, lawyers, and relatives of patients regarding the sensitive topic of voluntary cessation of life-sustaining therapy for the seriously ill. It was concluded that the cases that involve true ethical difficulties are much fewer than commonly believed and that the perception of difficulties primarily occurs because of misunderstandings about the dictates of law and ethics. It also is concluded that, while competent informed patients have the authority to decline or accept health care, others must act on the behalf of incompetent patients. The report urges that health care institutions develop and use internal review methods that permit exploration of all relevant issues. The 7 report chapters are grouped around 2 themes: the various aspects of making treatment decisions; and patient groups raising special concerns (e.g.: permanently-unconscious patients; seriously-ill newborns. (wz).

Americans seem to be increasingly concerned with decisions about death and dying. Why is a subject once thought taboo now so frequently aired by the popular media, debated in academic forums and professional societies, and litigated in well-publicized court cases? Perhaps it is because death is less of a private matter than it once was. Today, dying more often than not occurs under medical supervision, usually in a hospital or nursing home. Actions that take place in such settings involve more people, and the resolution of disagreements among them is more likely to require formal rules and means of adjudication. Moreover, patients dying in health care institutions today typically have fewer of the sources of nonmedical support, such as family and church, that once helped people in their final days. Also important, no doubt, are the biomedical developments of the past several decades. Without removing the sense of loss, finality, and mystery that have always accompanied death, these new developments have made death more a matter of deliberate decision. For almost any life-threatening condition, some intervention can now delay the moment of death. Frequent dramatic breakthroughs-insulin, antibiotics, resuscitation, chemotherapy, kidney dialysis, and organ transplantation, to name but a few-have made it possible to retard and even to reverse many conditions that were until recently regarded as fatal. Matters once the province of fate have now become a matter of human choice, a development that has profound ethical and legal implications. Moreover, medical technology often renders patients less able to communicate or to direct the course of treatment. Even for mentally competent patients, other people must usually assist in making treatment decisions or at least acquiesce in carrying them out. Consequently, in recent years there has been a continuing clarification of the rights, duties, and liabilities of all concerned, a process in which professionals, ethical and legal commentators, and-with increasing frequency-the courts and legislatures have been involved. Thus, the Commission found this an appropriate time to reexamine the way decisions are and ought to be made about whether or not to forego life-sustaining treatment. For example, may a patient's withdrawal from treatment ever be forbidden? Should physicians acquiesce in patients' wishes regarding therapy? Should they offer patients the option to forego life-sustaining therapy? Does it make any difference if the treatment has already been started, or involves mechanical systems of life support, or is very costly?

Breakthroughs in biomedicine often lead to new life-giving treatments but may also raise troubling, even life-and-death, quandaries. Society's Choices discusses ways for people to handle today's bioethics issues in the context of America's unique history and cultureâ€"and from the perspectives of various interest groups. The book explores how Americans have grappled with specific aspects of bioethics through commission deliberations, programs by organizations, and other mechanisms and identifies criteria for evaluating the outcomes of these efforts. The committee offers recommendations on the role of government and professional societies, the function of commissions and institutional review boards, and bioethics in health professional education and research. The volume includes a series of 12 superb background papers on public moral discourse, mechanisms for handling social and ethical dilemmas, and other specific areas of controversy by well-known experts Ronald Bayer, Martin Benjamin, Dan W. Brock, Baruch A. Brody, H. Alta Charo, Lawrence Gostin, Bradford H. Gray, Kathi E. Hanna, Elizabeth Heitman, Thomas Nagel, Steven Shapin, and Charles M. Swezey.

Emphasising the multi-disciplinary nature of palliative care the fourth edition of this text also looks at the individual professional roles that contribute to the best-quality palliative care.

Patient / Arzt.