Healthcare resource consumption in terminal care

Recent developments in healthcare have raised important ethical challenges. One of the trends is the increasing attention to patient autonomy for medical decision making. Patients are exercising greater authority to refuse medical treatment and to seek medical treatment that may end life. Another important trend is that end of life medical care has become increasingly expensive. Further, changes in reimbursement for medical care may create incentives for providers to deny heroic treatment. This article reviews issues relevant to these developments. We consider the issue of medical futility, the role of advance directives, and the international movement toward the legalisation of euthanasia. We suggest that futile medical treatment should not be offered and that advance directives should he used. However, review of the literature suggests that advance directives may not reduce medical costs. The effect of managed care upon advance directives, denial of heroic care and euthanasia is not known at this time.