| Families will struggle with these choices, regardless of | | | | considered at a later date. |
| whether withholding or withdrawing treatment is | | | | If the prognosis is poor from all points of view, and |
| being considered. For the ethics consultant, it's good | | | | lifesaving measures would only keep the body alive |
| to begin with the understanding that withholding and | | | | with no other prospects, then withholding treatment |
| withdrawing are moral and ethical equivalents. That | | | | seems most appropriate. |
| clears the playing field. | | | | Of course, these are hypotheticals and necessarily |
| It seems likely that family members who are | | | | sketchy. |
| guilt-ridden - for all the things they did to and for the | | | | A fresh perspective may be obtained by considering |
| dying relative and all the things they didn't do - will | | | | that our current medical expertise is only a modest |
| have great difficulty with any of these choices. As | | | | upgrade from the days of leeches and bleeding |
| they're losing their relative permanently, all the past | | | | patients. If the human race lasts another 300 years, |
| can now never be made right. So there's a strong | | | | future physicians and concerned citizens will look back |
| tendency to hold on regardless of the medical | | | | on the 21st century with much of the same horror |
| circumstances. | | | | and bemusement with which we view early |
| Such individuals could never be "responsible" for any | | | | 18th-century medicine. |
| proactive choice that would result in their relative's | | | | Cancer treatment provides a bracing context. |
| demise. As long as the relative lives, the family | | | | Chemotherapy, ablative surgery, and radiation may |
| member's fantasy of resolving the guilt can continue. | | | | be eventually viewed as barbaric rather than "heroic". |
| And, in no way could they be able to pile on more | | | | From another viewpoint, these methods may be the |
| imagined guilt than they already have. | | | | best we have right now. But that doesn't suggest |
| Withholding treatment might be more palatable, as | | | | they should be used in all cases. Case-by-case |
| the family member is only agreeing to the status quo. | | | | evaluation and treatment would be the most humane |
| Withdrawing treatment would require taking action | | | | approach. |
| that would change the present circumstances. The | | | | Similarly with percutaneous endoscopic gastrostomy |
| family member cannot take on that responsibility in | | | | (PEG)tubing. Whereas these may be useful in the ICU |
| the face of the unresolved issues. | | | | in cases in which survival and quality of life are real |
| For the most likely small minority of families who are | | | | considerations, such methods of artificial nutrition |
| able to let their loved ones go in a humane and | | | | hydration are not appropriate merely for ensuring |
| medically responsible manner, such questions might | | | | continued life. What's the value of being alive when |
| not arise. | | | | you're mostly dead? |
| Matters of withholding or withdrawing treatment | | | | In clinical bioethics, nothing is straightforward. It is |
| depend on the specifics of the case. If there are | | | | critically important to have an open mind and leave |
| reasonable expectations regarding quality and length | | | | one's prejudices and preconceptions at the hospital |
| of life, then beginning treatment with targeted | | | | entranceway. |
| reevaluation is appropriate. Withdrawal might be | | | | |