J Korean Med Assoc.  2019 Jul;62(7):350-357. 10.5124/jkma.2019.62.7.350.

Ethical and legal consideration on medical realities and ethical debates about withholding or withdrawing treatment in end-of-life care

• Kim MH
• Baik S

• KMID: 2452637
• DOI: http://doi.org/10.5124/jkma.2019.62.7.350

Abstract

It is natural for all human beings to die; hence, death is an inevitable event. However, advances in medical technology are changing the meaning of natural death. These advanced treatments provide the capability to intervene at the time of death and to reshape the circumstances around natural death, by sustaining human life. However, it is extremely difficult to judge when treatment is futile for the patient's best interests. It is therefore recommended to make time to discuss the concept of medical futility during the course of caring for a critically ill patient. Despite the expectations and efforts of the patient, the patient's family, and medical staff, the patient will eventually, have a "˜hopeless' medical condition. Most discussions about decision-making in end-of-life treatment have neen ethical debates focused on the patient's self-determination and best interest in the context of concepts such as euthanasia or death with dignity. However, such discussions are insufficient for resolving the wide variety of circumstances that occur in clinical settings. Instead, the various ethical dilemmas inherent to end-of-life care should be approached by educating medical teams, patients, and their families about how to recognize medical futility. Furthermore, it is important to optimize the balance between the rights of patients and the responsibility of physicians.

Keyword

Medical futility; Withholding treatment; Withdrawing treatment; Self determination; Euthanasia

MeSH Terms

Critical Illness
Euthanasia
Humans
Medical Futility
Medical Staff
Personal Autonomy
Right to Die
Withholding Treatment*

Reference

1. Karnik S, Kanekar A. Ethical Issues surrounding end-of-life care: a narrative review. Healthcare (Basel). 2016; 4:E24.

2. Act on Hospice-palliative Care and Life-sustaining Treatment Decision-making. No. 14013 (Feb 3, 2016).

3. Ku IH. Bioethics and philosophy. Philosophy and Reality Publishing;2000.

4. Merriam-Webster Learner's Dictionary. Euthanasia [Internet]. Massachusetts: Merriam-Webster [cited 2019 Jun 1]. Available from:. http://learnersdictionary.com/definition/Euthanasia.

5. Ryu JH. Ethical debate over euthanasia. J New Korean Philos Assoc. 2003; 31:43–73.

6. NCI Dictionary of Cancer Terms. Euthanasia [Internet]. Bethesda: National Cancer Institute [cited 2019 Jun 1]. Available from:. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/euthanasia.

7. Death with Dignity. What death with dignity means [Internet]. Portland: Death with Dignity National Center and Death with Dignity Political Fund [cited 2019 Jun 1]. Available from:. https://www.deathwithdignity.org/news/2017/07/death-with-dignity-means/.

8. Woo JM. Euthanasia and withdrawing the life-sustaining treatments, and their moral implications. Theol Philos. 2005; 7:111–143.

9. Oregon Health Authority. Oregon revised statue: Oregon's Death with Dignity Act [Internet]. Salem: Oregon Health Authority [cited 2019 Jun 1]. Available from:. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/ors.aspx.

10. Kim ST. Global trends in legalization of physician-assisted suicide. Korean J Med Law. 2018; 26:27–73.

11. Death with Dignity. New Jersey: current status [Internet]. Portland: Death with Dignity National Center and Death with Dignity Political Fund [cited 2019 Jun 1]. Available from:. https://www.deathwithdignity.org/states/new-jersey/.

12. World Federation of Right to Die Societies. Dutch law on termination of life on request and assisted suicide (complete text) [Internet]. [place unknown]: World Federation of Right to Die Societies [cited 2019 Jun 1]. Available from:. https://www.worldrtd.net/dutch-law-termination-life-request-and-assisted-suicide-complete-text.

13. Recent Belgian law reform [Internet]. Nova Scotia: End-of-Life Law and Policy in Canada [cited 2019 Jun 1]. Available from:. http://eol.law.dal.ca/wp-content/uploads/2014/02/Law-of-28-May-2002-on-Euthanasia-as-amended-by-the-Law-of-13-February-2014.pdf.

14. Department of Justice. Statutes of Canada 2016 [Internet]. [place unknown]: Government of Canada [cited 2019 Jun 1]. Available from:. https://laws-lois.justice.gc.ca/PDF/2016_3.pdf.

15. Parliamentary Library & Information Service. Voluntary Assisted Dying Bill 2017 [Internet]. East Melbourne: Parliament of Victoria [cited 2019 Jun 1]. Available from:. https://www.parliament.vic.gov.au/publications/research-papers/download/36-research-papers/13834-voluntary-assisted-dying-bill-2017.

16. Kim JH. The withdrawal of life-sustaining management for dying patients: a study in judicial precedents worldwide. J Korean Med Assoc. 2009; 52:856–864.

17. Framework Act on Health and Medical Services. No. 14558 (Feb 8, 2017).

18. Medical Service Act. No. 14438 (Dec 20, 2016).

19. Jun KB. Doctor's obligation of due care. Sungsin Law J. 2006; 5:43–79.

20. Lee BH. The right of patients information in the medical law. Hanyang Law Rev. 2005; 17:175–195.