As medical technologies evolve and assume greater importance in health care, individuals are confronted by situations that involve difficult ethical issues.
Autonomy, beneficence, and justice are ethical principles that apply to decision making in health care.
Informed consent requires that the patient is competent, understands the treatment options, and freely and voluntarily makes choices.
The high-profile cases of Karen Ann Quinlan, Nancy Cruzan, and Terri Schiavo have provoked public debate about dying in an era of sophisticated medical technology.
Terms describing various cognitive states—such as coma, minimally conscious, and vegetative—have become part of public discourse regarding medical ethics.
Physician-assisted death is permitted by legislation enacted in Oregon and Washington and by court ruling in Montana.
In 2013, the Vermont senate passed and the governor signed the "Patient Choice and Control at End of Life Act," adding Vermont to the list.
Physician-assisted suicide is increasingly an issue for national debate and legislative initiatives. In 1994, Oregon voters passed the Oregon Death with Dignity Act, making that state the first to legalize aid-in-dying. In March 1998, an elderly woman with breast cancer became the first known person to die under the law, having taken a lethal dose of barbiturates prescribed by her doctor.
The Patient Self-Determination Act, enacted into law by Congress in 1990, requires health care providers who receive federal funds to give information to patients concerning advance directives.
Euthanasia (a "good" or gentle and painless death) encompasses a range of medical decisions: choosing to withhold a particular treatment; withdrawing artificial life support or nutrition and hydration; administering high doses of pain medication that have the "double effect" of hastening death; providing a terminally ill person with the means to end his or her own life; and actively assisting in causing death (as in the case of a lethal injection administered by a physician).
Right-to-die advocates view euthanasia as a basic human right, an alternative to needless suffering. Opponents argue that it is often difficult or impossible to obtain a patient's clear consent to euthanasia, that there is always a risk of faulty diagnosis, that a timely cure may be found, that palliative care can ease pain and discomfort, and that opening the door to euthanasia will inevitably lead down a "slippery slope" toward inhumane and unethical practices.
Neonatal intensive care frequently involves painful decisions with respect to life-sustaining medical interventions.
Advance directives such as living wills and durable powers of attorney for health care provide a means for individuals to express their wishes about the use of life-sustaining treatment.
A will is a legal document expressing an individual's wishes and intentions with respect to the disposition of his or her property after death.
Probate is the legal process whereby a will is proved valid and an estate is distributed to its beneficiaries; it is conducted by an administrator or executor under supervision of a court.
Life insurance and other death benefits provide funds to survivors who have been named by the decedent as beneficiaries or who are otherwise entitled to the proceeds from such benefits.
End-of-life issues and decisions involve personal and cultural values and they affect public policies and the lives of individuals and families.
