Legal, moral concerns in life-support treatment decisions

Catholic health care facilities' responsibility to ensure that treatment decisions are based on the patient's best interests and sound medical practice rather than on the person's disability poses difficult legal and moral questions in cases involving terminally ill patients and handicapped newborns. For example, hospitals and physicians, to avoid undertreatment, may be induced to use all available life-sustaining technology. Such extraordinary measures, however, may not be in the patient's best interests if they place undue burden on the patient and family. Ordinary care, which usually means nourishment and hydration, also may be deemed morally optional. Some health care professionals, in light of new information about hydration's effects on terminal patients, suggest that no moral obligation to give ordinary care exists in certain "hopeless" cases. The prohibition in many facilities of written "do not resuscitate" orders also is a source of controversy. Appropriate guidelines, however, can help to reduce decision makers' uncertainty and ease the work of hospital personnel. The overriding concern, though, is who should make the decision to withhold or terminate treatment. In most cases the courts have assumed this responsibility themselves or have delegated it to others. Little consensus, however, has formed concerning whether family members, physicians, or hospital ethics committees are better able to make such decisions. Since few court rulings are available to guide those who must make treatment decisions, Catholic health professionals must stay abreast of the developing law and resist efforts to promote philosophies that measure life according to "quality" or productivity potential.