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Whose Death Is It, Anyway?
- Timothy Gilligan, MD; and
- Thomas A. Raffin, MD
- From Stanford University Center for Biomedical Ethics and Stanford University Medical Center, Stanford, California. Requests for Reprints: Thomas A. Raffin, MD, Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, MC 5236, 300 Pasteur Drive, Room H3151, Stanford, CA 94305-5236. Current Author Addresses: Dr. Gilligan: Department of Internal Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
Abstract
As medicine has increasingly gained the power to prolong life in the face of devastating illness, patients have increasingly become concerned about maintaining some control over how and when death arrives.Competent patients have the legal right to refuse treatment, but critically ill patients are frequently unable to participate in decision making. Advance directives were designed to help patients establish the level of care they would receive if they were to be rendered incompetent; yet, as the case discussed in this essay shows, even a valid advance directive does not guarantee that unwanted medical interventions will not be forced on us. The problem of physicians ignoring their patients' wishes goes beyond issues of communication and reflects an ongoing ambivalence about power and control in the physician–patient relationship. Unfortunately, many physicians find it easier to define success in terms of life and death than to try to determine what sort of existence is meaningful to an individual patient.
- Copyright ©2004 by the American College of Physicians
