CARING FOR THE DYING
The first issue regarding the dying individual is whether someone diagnosed with a terminal illness
should be told about it. Traditional medical ethics held that the physician's duty was to do what he or she thought would benefit the patient. Many physicians believed that disclosing the diagnosis of a terminal illness would be upsetting and therefore withheld it. This is still a common practice in some countries, including Japan and the Latin American countries. In the United States, that traditional ethic has been replaced by one that affirms that the patient has the right to know the diagnosis and to make an informed choice about what kind of
treatment to accept.
Many people believe that it is morally acceptable to let a patient die if that patient or the patient's legitimate surrogate declines life-sustaining treatment. Treatments that are
considered useless or disproportionately burdensome based on the patient's values are considered refusable. In the case of an infant or child or an incompetent adult who left no record or wishes, the next-of-kin is considered the valid surrogate and can make decisions to accept or refuse life support provided their choices are within reason.
In the United States, the right to refuse treatment is widely accepted by groups including the President's Commission for the Study of Ethical Problems in Medicine, the Roman Catholic church, the American Medical Association, and the courts. It is gaining acceptance in other countries, but legal and ethical practices vary. The right to refuse treatment does not imply there is a similar right to euthanasiaÑactive intervention to kill for mercy or assistance in suicide. Mercy killing is illegal in all countries, although it is accepted by an informal agreement in the Netherlands. Various countries are debating the legalization of assisted suicide. Withdrawing of life support, based on the patient's or surrogate's withdrawal of consent, is generally considered legally and ethically comparable to refusing to start treatment rather than active killing.
While refusal of life support was the primary controversy of the 1970s and '80s, increasing concerns about the cost of sustaining life have led to proposals to stop life support even against the patient's wishes. Usually, this action is proposed for patients who are permanently unconscious or dying rapidly. Continued life support is deemed "futile" or without value, based on the values of the proponent of such policies. Often, however, patients and family members who demand continued life support believe that it is worth prolonging life even when the outcome will inevitably be permanent unconsciousness or rapid death. To date, the U.S. courts have sided with those who want such treatment, at least in cases in which others are not directly harmed by providing it.