Substituted judgement: how accurate are proxy predictions?

Article Abstract:

Most physicians and medical ethicists agree that a patient has the right to make the final decision regarding his or her health care. However, the situation becomes more complicated if the patient suffers some mentally incapacitating condition. In such cases, critical medical decisions are often made by family members and personal physicians. It is not clear, however, that the decisions made by these individuals accurately reflect the decisions that would have been made by the patient. This situation will become more common, because the advancing average age of the population is increasing the number of people who develop dementia and, therefore, cannot make rational decisions regarding their own health care. For this reason, a study was conducted involving 70 chronically ill patients with an average age of 78. The patients were presented with scenarios in which they suffered cardiac arrest, either in their present condition of health or as demented patients. The wishes expressed by the patients regarding these hypothetical scenarios were then compared with the opinions expressed by their personal physicians and close family members. Ninety percent of the patients felt that their physicians would accurately represent their wishes, and 87 percent felt that their close family members would do the same. However, these opinions turned out to be incorrect, as neither the physicians nor family members adequately predicted the patients' wishes. For example, for the scenario involving dementia, the opinions of the physicians were different than the patients' expressed wishes 41 percent of the time. In 61 percent those discrepancies, the patient expressed the desire for treatment, which the physician would have withheld. Only 16 percent of the patients had actually discussed their desires with their families, and fewer still, 7 percent, had discussed such topics with their personal physician. The results of this study indicate that close family members and physicians cannot be counted on to accurately reflect the desires of the patients, and that steps should be taken to ensure that patients' true wishes are recorded in some fashion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Right to refuse treatment, Right to die, Treatment refusal, Resuscitation, Life and death, Power over, Power over life and death

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Voluntary death: a comparison of terminal dehydration and physician-assisted suicide

Article Abstract:

Terminal dehydration may be an acceptable alternative to physician-assisted suicide. A patient who chooses terminal dehydration would simply stop drinking and eating. Death would occur several days to several weeks later and most patients would become unconscious before death. Evidence indicates that this is not extremely painful, and any discomfort could be managed with analgesics, sedatives or other drugs. Competent patients have the right to refuse treatment, and terminal dehydration would be in that category. It would require no legal or ethical changes and many physicians might not object to this method of terminating life.

Patient outcomes, Mortality, Terminally ill persons, Terminally ill, Dehydration (Physiology)

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The debate over physician-assisted suicide: empirical data and convergent views

Article Abstract:

Physicians who oppose physician-assisted suicide can still do much to reduce suffering experienced by the dying patient. Proper attention to palliative care might eliminate requests for physician-assisted suicide. Palliative care includes effective treatments for pain and depression. Terminal sedation and voluntary discontinuation of eating and drinking may be acceptable in those patients whose suffering cannot be reduced by palliative care. Better palliative care will allow physicians to care for dying patients without violating their own values.

Assisted suicide, Palliative treatment, Palliative care

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