An ethical framework for clinical decision-making at the end of life.

摘要: Because of advances in medicine, decision-making at the end life is no longer simple. Public debate on television and articles journals demonstrate need for an ethical framework to solve moral dilemmas caring irreversibly ill. This paper proposes three principles that should underpin medical behaviour. During years' research we set out determine practical problems senior staff were facing by interviewing small groups Royal Society Medicine. We invited individuals from anaesthesia, general practice, geriatrics, neurosurgery neurodisability, oncology, palliative care. Three participants chosen because their published support euthanasia, advance directives or 'pro-life' campaigns. Later, involved junior hospital doctors, nursing therapy staff, practitioners, pensioners' groups, ethicists chaplains. Whilst duty provide care sick incumbent whole society, knowledge training doctors gives them special responsibilities. However, our it soon became obvious among practitioners there a vacuum this question. arises have both respect human accept mortality man. At all levels was confusion about questions such as 'Who responsible death when treatment withdrawn?' 'Why not necessary always treat?'. could be stated simply over distinction between killing letting die. outset clear problem begins with difference two extremes keeping patient alive costs (vitalism) seeking bring (euthanasia).