Treatment Decisions in the Mentally Impaired

New England Journal of MedicinePublished 3 December 1987

Erich H. Loewy

DOI10.1056/nejm198712033172308

Source URL

Citations23

SJR quartileQ1

SJR score19.08

SNIP13.47

TL;DR

In working with mentally impaired patients of any age, the authors frequently encounter the problem of what treatment is and is not justified, and physicians may think that although all-out measures to treat patients are necessary, they are not justified.

Abstract

Rejecting the "absolutist" stand that all forms of life-sustaining\ntreatment are ethically mandated until a decision is made to discontinue\ntreatment, the author probes the issue of how aggressively to treat mentally\nimpaired patients of any age. He discusses the goals of medicine and the\nextent of the physician's obligation to sustain life, and then suggests\nguidelines that could be used to determine that certain types of treatment may\nbe limited whereas others may not. These guidelines take into account the\nimmediacy of the threat, the relievable suffering caused by the disease, the\nsuffering produced by the treatment, and the patient's capacity for sustained\nunderstanding of the treatment and for cooperation with the regimen. (KIE\nabstract)

Keywords

MedicineNeuroscience

JAMAA Definition of Irreversible Coma

1,398 Citations1968

New England Journal of MedicineThe Physician's Responsibility toward Hopelessly Ill Patients

437 Citations1984Wanzer Sh, Adelstein Sj +8 more

The value of a sensitive approach to care is emphasized — one that is adjusted continually to suit the changing needs of the patient as death approaches, even when such use may result in shortened life.

The Hastings Center ReportThe Tyranny of Principles

264 Citations1981Stephen Toulmin

The revival of a tyrannical absolutism in recent discussions about social and personal ethics is proposed, reflected in attitudes toward politics, public affairs, and the administration of justice, as much as toward questions of "ethics".

JAMATo Save or Let Die

185 Citations1974Richard A. McCormick

On Feb 24, the son of Mr and Mrs. Robert H. T. Houle died following court-ordered emergency surgery at Maine Medical Center after he was afflicted with a tracheal esophageal fistula and could not be fed by mouth.

The Hastings Center ReportThe Physician's Obligation to Prolong Life: A Medical Duty without Classical Roots

123 Citations1978Darrel W. Amundsen

New England Journal of MedicineAllowing the Debilitated to Die

107 Citations1983David Hilfiker

The phone wakes me; it is 3 a.m. and in an instant I remember Elsa Toivonen, 83 years old: her dislike and distrust of doctors and hospitals, her staunch pride and independence despite her severe scoliosis, her wry grin every time I suggested hospitalization for some problem.

Journal of Clinical GastroenterologyDrunks, Livers, and Values

43 Citations1987Erich H. Loewy

The paper concludes that "social worth," as a criterion for distribution of scarce resources, is morally precluded in allocations directly involving the patient-physician relationship and social worth criteria may be useful in macroallocation decisions prior to resorting to a lottery approach or to a market approach.

Social Science & MedicinePrinciples and the search for moral certainty

31 Citations1986Larry R. Churchill, JoséJorge Simán

In medical ethics, principles have an important but frequently overextended role, and a more fitting role for principles is described and illustrated, stressing the use of principles as tools of moral discernment and the time-laden character of moral judgments.

The Hastings Center ReportThe Right to Die

23 Citations1978Hans Jonas

The environment is human, and the accommodation it accords has a voluntary element in it, such inclusive accommodation underlying all communal life amounts to an implicit granting by the many of the individual's right to live and his granting the same to all others.