Therapeutic Overzealousness. A Debate on Criteria for Withholding and Withdrawing Life-Sustaining Treatment

Abstract

Greater human longevity is one of the biggest achievements of medicine. Timely medical interventions save countless human lives. But some of them, especially those undertaken in the face of imminent death, often generate serious ethical dilemmas. After reaching a certain critical point, the otherwise welcomed and blessed possibilities of prolonging life sometimes degenerate into a painful prolongation of dying. A spontaneous moral intuition, as well as a more balanced, careful ethical reflection – for which human life constitutes the highest value – permits withdrawal of ineffective therapy. But just what are the criteria for making that crucial decision to terminate a medical therapy? How does one define them? The article opens with the overview of terminology applied to medical interventions that fall into the category of inadequate treatment, both from the perspective of medical futility (futile treatment), the standpoint of the physician (overzealous treatment) and the actual suffering of the patient (burdensome treatment). It then examines the criteria for the termination of treatment, among which the prognosis of imminent death and disagreements over the extent of the basic medical care play crucial roles. The final parts of the article focus on some additional, though by no means less important, issues relating to end of life, like the truth at the sickbed, patient’s advance decision concerning the extent of medical interventions he is willing to accept and the physician’s conscience clause.