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Quotations from "The Appleton Consensus: Suggested International Guidelines for Decisions to Forgo Medical Treatment"
(For full document, see Lawrence University site for The Appleton Consensus)
From Part I -- Requests for
treatment:
"Doctors also have a strong prima
facie obligation to respect patients'
requests for life-prolonging
treatment. However, certain qualifications are relevant: (a)
Doctors are not obliged to provide physiologically futile treatments
(ie
treatments that cannot produce the desired physiological change). Where
a
doctor considers a life-prolonging
treatment not to be physiologically futile, but nonetheless 'futile' in
another
sense of the word because of the low probability of success or because
of the low quality of life that would remain,
then decisions about the withholding or withdrawal of such treatments
should be
made in the context of full and open discussion of the nature and
extent of the
'futility' of the treatment with the patient or the patient's
representative; . . . (c) If a doctor has a conscientious objection to
a
requested treatment that doctor is not obliged to provide it. The
doctor should explain all
treatment options and his or her position regarding them. If the
patient
wishes, the doctor should arrange an orderly transition to another
doctor of
the patient's choice; (d) Scarcity of resources may sometimes require
overriding a patient's request
for a life-prolonging
treatment (see Part IV)
From Part II -- "Decisions
involving patients who have lost the capacity to make decisions:"
"Intervention with the primary
intention of causing death (as distinguished
from forgoing treatment that is deemed inappropriate) has no place in
the
treatment of permanently incapacitated patients. However, vigorous treatment to
relieve pain and suffering may well be justified, even if these
interventions
lead to an earlier death."
From
Part IV -- withdrawing treatment "under conditions of scarcity," on the role of
- Justice in the decision-making: "Respect for the total benefit of society
would require that whenever medical
procedures that could be beneficial to individuals have to be limited
because
of scarcity, available resources should be allocated among persons so
that they
produce the greatest overall
utility. Such allocation inevitably conflicts with
respect for the ethical dimensions of both need and property."
- Efficiency:
"The maxim of efficiency follows from the principles of non-maleficence
and beneficence. It requires that a given expected outcome of any
medical
procedure, including a life-prolonging
procedure . . ought to be achieved at the least opportunity-cost. The
force of the principle derives from the fact that, should the
principle not be met, fewer resources would be available, either
immediately or
at some future date, for accomplishing other desired and ethical
outcomes. . . . [W]hen resources available
to the doctor are limited, efficiency
requires that resources ought not to be employed if the benefits to a
particular patient are judged to be less than the benefits denied to
others for
whom the same doctor has responsibility."
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