Ethical decision-making in the care of the dying and its applications to clinical practice

In caring for dying patients, physicians and health team members face a number of decisions about how best to proceed with treatment. Many of these decisions carry implications for the life of the patient, either directly or indirectly. Recent discussions about the morality and wisdom of euthanasia provide an excellent stimulus to reexamine the ethical nature of these decisions. This paper reviews five ethical principles, and describes a process of decision-making that can result in two broad paths of action in relation to life-prolonging treatment. Case examples are presented for illustration. Appropriate ethical practice can be differentiated from acting with the primary intent to take life (euthanasia).