[ETHICS OF THE LIMITATION OF LIFE-SUSTAINING TREATMENTS]

The development over the last half century of the Life Support Technologies and the advent of the Intensive Care Units, have raised a wide range of new problems for ethical reflection. It is not by chance that the birth of Bioethics coincided with the birth of the Intensive Care Units. The first and most important of these problems is the withholding or withdrawing of the life support measures. In this article it is argued that the decision to limit life-sustaining treatments may be justified in four different ways, according with the four bioethical principles: by the expressed will of the patient or his/her representative, considering the procedure "extraordinary" for them (principle of autonomy); due to the lack of efficacy of the technique in question, which makes it "non-indicated" or "contraindicated" (principle of non-maleficence); due to problems of efficiency in the distribution of resources, which can make "disproportionate" the cost/benefit ratio of an specific treatment (principle of justice); and finally, due to the lack of effectiveness of some therapeutic procedures in concrete situations, which makes them "futile" (principle of beneficence).