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[End-of-life decision-making process].

Avraham Steinberg

    Harefuah
    |October 21, 2003
    PubMed
    Summary

    Terminally-ill patients and their families are excluded from end-of-life decisions, including Do Not Resuscitate (DNR) orders, in Israeli hospitals. This unethical paternalism necessitates immediate societal intervention for improved patient autonomy in medical ethics.

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    Area of Science:

    • Medical Ethics
    • Palliative Care
    • Health Law

    Background:

    • Global diversity in philosophical, religious, social, and legal approaches complicates end-of-life decision-making for dying patients.
    • Israel lacks a consensus on practices for dying patients, with no published data on decision-making processes in healthcare facilities.
    • A study at Shaare Zedek Medical Center investigated decision-making for Do Not Resuscitate (DNR) orders.

    Discussion:

    • The study revealed that terminally-ill patients are consistently excluded from decisions regarding their care, with no consultation on their wishes.
    • Families were often not involved in the decision-making process for DNR orders.
    • A significant minority of DNR decisions were made unilaterally by a single physician, highlighting unethical paternalism.

    Key Insights:

    • Complete exclusion of patients and families from end-of-life medical decisions, particularly DNR orders.
    • Prevalence of physician-led, paternalistic decision-making, disregarding patient autonomy and prior wishes.
    • Urgent need for societal intervention to establish ethically sound decision-making processes.

    Outlook:

    • The Steinberg Committee has proposed legislation balancing autonomy, life, quality-of-life, beneficence, and non-maleficence for end-of-life care.
    • The proposal addresses various treatment modalities, euthanasia, physician-assisted suicide, and treatment withdrawal/withholding.
    • It establishes a hierarchy for decision-making agents, validates advanced medical directives, and mandates palliative care.

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