The evolution of the patient’s clinical course usually indicates when the time has arrived to discontinue life-sustaining treatment and to allow a patient to die. However, time is not always on the physician’s or the patient’s side. The conscious, alert, and ventilator-dependent patient certainly presents one of the greatest and most difficult challenges to clinicians […]

Although several guidelines have stated that patients are not obliged to undergo, and physicians are not obliged to offer, begin, or continue treatments that are futile, there is continuing confusion and controversy about the meaning and usefulness of futility as an indicator for the withholding or withdrawal of treatments.
In this section, the futility of an […]

The principle of proportionality, succinctly stated, affirms that life-prolonging treatments are contraindicated when they cause more suffering than benefit. This principle also comes to expression in the Canadian Law Reform Commission’s recommendation that the Criminal Code should not bind physicians to administer therapeutically useless treatments or treatments that conflict with a patient’s best interests. Other […]

The method of clinical ethics in palliative medicine, outlined in the section on clinical ethics, will now be exemplified in a series of considerations of when and why it is ethically justified to withhold or to discontinue life-extending therapy. These considerations refer to the principles most frequently invoked when decisions about treatment have to be […]