Emeritus Faculty, Acad Council, Medicine
View details for PubMedID 16528859
View details for PubMedID 8149005
View details for PubMedID 8436929
View details for PubMedID 1342338
Despite impressive recent advances in neonatology, outcomes for extremely premature, very-low-birth-weight infants (500 to 750 g) remain uneven. In a situation of inherent uncertainty, treating patients vigorously could do violence to the moral principles of nonmaleficence and (distributive) justice. Equally, failing to treat patients vigorously because of concerns about nonmaleficence and (distributive) justice could violate the principle of patient-centered beneficence. Compounding this dilemma is the legacy of the "Baby Doe Regulations." International perspectives on this particular quandary are provided. We assert that at Stanford (Calif) University the "individualized prognostic strategy" rather than the "wait until certainty" approach prevails. Four concluding questions are posed: Why is prevention not encouraged more than after-the-fact heroic intervention? Is it possible to develop a more rational view of stopping aggressive therapy once having started? Can we ignore the finitude of our medical resources? Is there a need to redefine the nature of autonomy?
View details for Web of Science ID A1990DB96200021
View details for PubMedID 2330921
View details for PubMedID 2657792
There are three levels at which nontreatment decisions for patients with cancers of the head and neck might be made: not doing further diagnostic procedures when the data gained would not make a significant difference to treatment decisions; not continuing aggressive therapy when its benefits are outweighed by the ensuing burdens and harms; and, at the policy level, not providing costly aggressive therapy at all because of the number of patients with unmet, more basic needs. These three levels of nontreatment decisions are discussed in light of ethical theory, briefly introduced. Arguments are made in favor of nontreatment decisions at the two clinical levels mentioned above, but against a policy decision to ration treatment for patients with cancers of the head and neck.
View details for Web of Science ID A1991FV56600017
View details for PubMedID 1907464