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Commentary: balancing life and death--proceed with caution

N N Dubler1

  • 1Department of Epidemiology and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467.

American Journal of Public Health
|January 1, 1993
PubMed
Summary
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Hospital professionals face complex decisions regarding end-of-life care, balancing medical, ethical, and legal factors. Institutional culture must evolve to support negotiated death, addressing patient fears and legal concerns.

Area of Science:

  • Medical Ethics
  • Healthcare Law
  • End-of-Life Care

Background:

  • Medical training and healthcare systems prioritize treatment over facilitating death.
  • Patient rights to refuse care can be misunderstood, leading to fears of abandonment.
  • Legal and risk management concerns may unduly restrict patient autonomy.

Observation:

  • Decisions permitting death involve intricate medical, ethical, and legal considerations.
  • Healthcare professionals are primarily educated and socialized to provide treatment.
  • Patient and family rights at the end of life are sometimes limited by institutional practices.

Findings:

  • Healthcare culture often conflicts with the concept of negotiated death.
  • Exaggerated liability fears can impede the recognition of patient and family rights.
Keywords:
Death and Euthanasia

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  • A shift in institutional culture is necessary to accommodate end-of-life decision-making.

    • Implications:

    • Healthcare institutions need to adapt their culture to better support patients' end-of-life choices.
    • Addressing fears of abandonment and liability is crucial for respecting patient autonomy.
    • Facilitating negotiated death requires a systemic change in medical education and practice.