Ethical issues in end-of-life care

Technical advances in the care of advanced illness have created ethical challenges for physicians, patients, and families at the end of life. In the effort to survive longer, they are often confronted with difficult choices regarding medical advances that may inadvertently prolong suffering and the dying process rather than bring healing and recovery. Four major principles of medical ethics assist patients, families, and their physicians in making meaningful and morally acceptable choices with respect to care at the end of life: the Hippocratic principles of nonmaleficence and beneficence, as well as the more recently developed principles of autonomy and justice. The nature of these principles and their application in decision making and communication during the care of patients with advanced illnesses are reviewed.