Analiza i Egzystencja

ISSN: 1734-9923     eISSN: 2300-7621    OAI    DOI: 10.18276/aie.2018.42-01

Lista wydań / 42 (2018)
Withholding and Withdrawing Life-Saving Treatment: Ordinary/Extraordinary Means, Autonomy & Futility

Autorzy: Alan Kearns
Dublin City University

Bert Gordijn
Dublin City University
Słowa kluczowe: równoważenie środki nadzwyczajne daremność porządkowanie leksykalne środki zwyczajne autonomia pacjenta prima facie zaniechanie i zaprzestanie stosowania środków medycznych
Rok wydania:2018
Liczba stron:29 (5-33)
Cited-by (Crossref) ?:


W artykule zarysowujemy trzy zasady określające refleksję etyczną nad zaniechaniem i zaprzestaniem stosowania środków medycznych podtrzymujących życie: 1) zasadę zwyczajnych i nadzwyczajnych środków medycznych 2) zasadę poszanowania autonomii pacjenta i 3) zasadę daremności. Gdy należy podjąć decyzję o stosowaniu albo zaniechaniu/zaprzestaniu stosowania środków medycznych, zasady te zapewniają perspektywę normatywną służącą stwierdzeniu, jakie postępowanie jest obowiązkowe. Każda z zasad ustanawia jednak inny obowiązek, co prowadzi do konfliktu i naglącym czyni pytanie, której z nich należy przyznać pierwszeństwo. Po naszkicowaniu powszechnie uznanych sposobów rozsądzania konfliktu zasad etycznych, stosujemy do zasad zwyczajnych i nadzwyczajnych środków medycznych, poszanowania autonomii pacjenta i daremności zaproponowaną przez Veatcha mieszaną strategię równoważenia i porządkowania leksykalnego. Przedstawiamy w naszym artykule opinię, że aczkolwiek rozwiązanie konfliktu zasad nigdy nie jest łatwe, to jednak przyjęcie mieszanej strategii równoważenia i porządkowania leksykalnego pozwala posunąć naprzód dyskusję nad obowiązkami etycznymi odnoszącymi się do zaniechania i zaprzestania stosowania środków medycznych podtrzymujących życie.
Pobierz plik

Plik artykułu


1.Aghabarary, M. and Nayeri, N. D. (2016). Medical Futility and its Challenges: A Review Study. Journal of Medical Ethics and History of Medicine, 9 (11), 1–13.
2.Agich G. J. (1990). Reassessing Autonomy in Long-Term Care. The Hastings Center Report, 20 (6), 12–17.
3.Ashley, B. M. and O’Rourke, K. D. (2002). Ethics of Health Care: An Introductory Textbook, 3rd edition. Washington DC: Georgetown University Press.
4.Atwell, J. (1978). Ross and Prima Facie Duties. Ethics, 88 (3), 240–249.
5.Baines, P. (2008). Medical Ethics for Children: Applying the Four Principles to Paediatrics. Journal of Medical Ethics, 34 (3), 141–145.
6.Bailey, S. (2003). The Concept of Futility in Health Care Decision Making. Nursing Ethics, 11 (1), 77–83.
7.Beauchamp, T. L. (2003). Ethical Theory and Bioethics. In: T. L. Beauchamp and L. Walters (ed.), Contemporary Issues in Bioethics, 6th edition (pp. 1–27). New York: Wadsworth.
8.Beauchamp, T. L. and Childress, J. F. (2013). Principles of Biomedical Ethics, 7th edition. New York: Oxford University Press.
9.Bedford, E.L. (2011). Of Food and Water and the Obligation to Provide: John Paul II and Christian Anthropology. Christian Bioethics, 17 (2), 105–122.
10.Beever, J. and Brightman, A. O. (2016). Reflexive Principlism as an Effective Approach for Developing Ethical Reasoning in Engineering. Science and Engineering Ethics, 22 (1), 275–291.
11.Bernat, J. L. (2005). Medical Futility: Definition, Determination, and Disputes in Critical Care. Neurocritical Care, 2 (2), 198–205.
12.Biggar, N. (2004). Aiming to Kill: The Ethics of Suicide and Euthanasia. London: Darton, Longman & Todd.
13.Bretzke, J. T. (2013). Handbook of Roman Catholic Moral Terms. Washington, DC: Georgetown University Press.
14.Brody, H. (1985). Autonomy Revisited: Progress in Medical Ethics: Discussion Paper. Journal of the Royal Society of Medicine, 78 (5), 380–387.
15.Brown, G. T. (2014). Clarifying the Concept of Medical Futility. National Catholic Bioethics Quarterly, 14 (1), 39–46.
16.Buchanan, A. (1978). Medical Paternalism. Philosophy & Public Affairs, 7 (4), 370–390.
17.Calipari, M. (2004). The Principle of Proportionality in Therapy: Foundations and Applications Criteria. NeuroRehabilitation, 19 (4), 391–397.
18.Callahan, D. (1984). Autonomy: A Moral Good, Not a Moral Obsession. The Hastings Center Report, 14 (5), 40–42.
19.Catechism of the Catholic Church (2003).
21.Chandler, J. A. (2011). ‘Obligatory Technologies’ and the Autonomy of Patients in Biomedical Ethics. Griffith Law Review, 20 (4), 905–930.
22.Childress, J. F. (2007). Methods in Bioethics. In: B. Steinbock (ed.), The Oxford Handbook of Bioethics (pp. 15–45). Oxford: Oxford University Press.
23.Clark, P. (2006). Tube Feedings and Persistent Vegetative State Patients: Ordinary or Extraordinary Means? Christian Bioethics, 12 (1), 43–64.
24.Coy, J. (1989). Autonomy-Based Informed Consent: Ethical Implications for Patient Non-compliance. Journal of Physical Therapy Science, 69 (10), 826–833.
25.Cronin, D. A. (1989). The Moral Law in Regard to the Ordinary and Extraordinary Means of Conserving Life. In: R. E. Smith (ed.), Conserving Human Life, (pp. 1–145). Braintree, Mass.: Pope John Center.
26.Dawson, A. and Garrard, E. (2006). In Defence of Moral Imperialism: Four Equal and Universal Prima Facie Principles. Journal of Medical Ethics, 32 (4), 200–204.
27.Demarco, J. P. and Ford, P. J. (2006). Balancing in Ethical Deliberation: Superior to Specification and Casuistry, Journal of Medicine and Philosophy, 31 (5), 483–497.
28.Dooley, D. and McCarthy, J. (2005). Nursing Ethics: Irish Cases and Concerns. Dublin: Gill & Macmillan.
29.Downie, R. S. and Telfer, E. (1971). Autonomy. Philosophy, 46 (178), 293–301.
30.Escalante, C. P., Martin, C. G., Elting, L. S. and Rubenstein, E. B. (1997). Medical Futility and Appropriate Medical Care in Patients whose Death is Thought to be Imminent. Support Care Cancer, 5 (4), 274–280.
31.Fagan, A. (2004). Challenging the Bioethical Application of the Autonomy Principle within Multicultural Societies. Journal of Applied Philosophy, 21 (1), 15–31.
32.Fischer, A. (2012). Catholic Bioethics for a New Millennium. Cambridge: Cambridge University Press.
33.Fontugne, E. A. (2014). To Treat or Not to Treat: End-Of-Life Care, Patient Autonomy, and the Responsible Practice of Medicine. Journal of Legal Medicine, 35 (4), 529–538.
34.Gampel, E. (2006). Does Professional Autonomy Protect Medical Futility Judgments? Bioethics, 20 (2), 92–104.
35.Gibson, K. (2014). An Introduction to Ethics. Boston: Pearson.
36.Gillon, R. (1986a) Ordinary and Extraordinary Means. British Medical Journal (Clinical Research Edition), 292 (6515), 259–261.
37.Gillon, R. (1986b) Where Respect for Autonomy is not the Answer. British Medical Journal (Clinical Research Edition), 292 (6512), 48–49.
38.Gillon, R. (1994). Medical Ethics: Four Principles Plus Attention to Scope. British Medical Journal, 309 (6948), 184–188.
39.Gillon, R. (1997). “Futility”: Too Ambiguous and Pejorative a Term? Journal of Medical Ethics, 23 (6), 339–340.
40.Gómez, F. J. I. and Meana, P. R. (2017). Is Medical Futility an Ethical or Clinical Concept? National Catholic Bioethics Quarterly, 17 (2), 261–273.
41.Greaney, A.-M. and O’Mathúna, D. P. (2017). Patient Autonomy in Nursing and Healthcare Contexts. In: P. A. Scott (ed.), Key Concepts and Issues in Nursing Ethics. (pp. 83–99). Cham: Springer.
42.Halliday, R. (1997). Medical Futility and the Social Context. Journal of Medical Ethics, 23 (3), 148–153.
43.Have, H. T. (2016). Global Bioethics: An Introduction. London: Routledge Taylor & Francis Group.
44.Heft, P. R., Siegler, M., Lantos J. (2000). The Rise and Fall of the Futility Movement. The New England Journal of Medicine, 343 (4), 293–296.
45.Heinrichs, B. (2010). Single-Principle versus Multi-Principles Approaches in Bioethics. Journal of Applied Philosophy, 27 (1), 72–83.
46.Jecker, N. S. (1995). Medical Futility and Care of Dying Patients. Western Journal of Medicine, 163 (3), 281–291.
47.Jecker, N. S. and Schneiderman, L. J. (1993). Medical Futility: The Duty Not to Treat. Cambridge Quarterly of Healthcare Ethics, 2 (2), 151–159.
48.Kasman, D. L. (2004). When Is Medical Treatment Futile? A Guide for Students, Residents, and Physicians. Journal of General Internal Medicine, 19 (10), 1053–1056.
49.Kelly, D. F., Magill, G. and Have, H. T., (2013). Contemporary Catholic Health Care Ethics, 2nd edition. Washington DC: Georgetown University Press.
50.Kelly, G. (1950). The Duty of Using Artificial Means of Preserving Life. Theological Studies, 11 (2), 203–220.
51.Kelly, G. (1951). The Duty to Preserve Life. Theological Studies, 12 (4), 550–556.
52.Kelly, G., (1958). Medico-Moral Problems. St. Louis: The Catholic Health Association of the United States and Canada.
53.Komrad, M. S. (1983). A Defence of Medical Paternalism: Maximising Patients’ Autonomy. Journal of Medical Ethics, 9 (1), 38–44.
54.Lillie, W. (1966). An Introduction to Ethics, reprint. London: Methuen & Co.
55.Lynn, J. and Childress, J. F. (1983). Must Patients Always Be Given Food and Water? The Hastings Center Report, 13 (5), 17–21.
56.McCartney, J. J. (1980). The Development of the Doctrine of Ordinary and Extraordinary Means of Preserving Life in Catholic Moral Theology before the Karen Quinlan Case. The Linacre Quarterly, 47 (3), 215–224.
57.Mallia, P. (2013). The Nature of the Doctor-Patient Relationship: Health Care Principles through Phenomenology of Relationships with Patients. Heidelberg: Springer Dordrecht.
58.May, T. (1994). The Concept of Autonomy. American Philosophical Quarterly, 31 (2), 133–144.
59.Meilaender, G. (2005). Bioethics: A Primer for Christians, 2nd edition. Grand Rapids: William B. Eerdmans.
60.Miles, S. H. (1992). Medical Futility. Law, Medicine & Health Care, 20 (4), 310–315.
61.Molyneux, D. (2009). Should Healthcare Professionals Respect Autonomy Just Because It Promotes Welfare? Journal of Medical Ethics, 35 (4), 245–250.
62.Moratti, S. (2009). The Development of “Medical Futility”: Towards a Procedural Approach Based on the Role of the Medical Profession. Journal of Medical Ethics, (36), 369–37.
63.Nessa, J. and Malterud, K. (1998). Tell Me What’s Wrong with Me: A Discourse Analysis Approach to the Concept of Patient Autonomy. Journal of Medical Ethics, 24 (6), 394–400.
64.Nuremberg Code (1949). The Nuremberg Code. Trials of War Criminals before the Nuremberg Military Tribunals under Control Council Law, 10 (2), 181–182.
66.Newham, R. A. and Hawley, G. (2007). The Relationship of Ethics to Philosophy. In: G. Hawley (ed.), Ethics in Clinical Practice: An Interprofessional Approach (pp. 76–100). Harlow: Pearson.
67.Oviedo Convention (1997) Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine, Oviedo, 4.IV.
69.Panicola, M. (2001). Catholic Teaching on Prolonging Life: Setting the Record Straight. The Hastings Center Report, 31 (6), 14–25.
70.Paulo, N. (2016). The Confluence of Philosophy and Law in Applied Ethics. London: Palgrave MacMillan.
71.Pellegrino, E. D. (1990). The Relationship of Autonomy and Integrity in Medical Ethics. Bulletin of the Pan American Health Organization, 24 (4), 361–371.
72.Pellegrino, E.D. (2000). Decision at the End of Life: The Use and Abuse of the Concept of Futility. In: J. W. Koterski (ed.), Life and Learning X Proceedings of the Tenth University Faculty for Life Conference (pp. 85–110).. Washington, DC: Georgetown University.
73.Pellegrino, Edmund D. and Thomasma, David C. (1987) The Conflict between Autonomy and Beneficence in Medical Ethics: Proposal for a Resolution. Journal of Contemporary Health Law & Policy, 3 (1), 23-46.
74.Pope Pius XII (1999). The Prolongation of Life., In: K. D. O’Rourke and P. Boyle (ed.), Medical Ethics: Sources of Catholic Teachings, 3rd edition (pp. 280–281),. Washington, D.C.: Georgetown University Press.
75.Pope John Paul II (1995). Evangelium Vitae.
76.Post, S. G. (1995). Baby K: Medical Futility and the Free Exercise of Religion. Journal of Law, Medicine & Ethics, 23 (1), 20–26.
77.Quante, M. (2011). In Defence of Personal Autonomy. Journal of Medical Ethics, 37 (10), 597–600.
78.Ross, W. D. (2002) The Right and the Good, P. Stratton-Lake (ed.). Oxford: Clarendon Press.
79.Sacred Congregation for the Doctrine of the Faith (SCDF) (1980). Declaration on Euthanasia.
80.Schneiderman, L. J. (2011). Defining Medical Futility and Improving Medical Care. Journal of Bioethical Inquiry, 8 (2), 123–131.
81.Schneiderman, L. J., Jecker, N. S., Jonsen, A. R. (1990). Medical Futility: Its Meaning and Ethical Implications. Annals of Internal Medicine, 112 (12), 949–954.
82.Schwartz, R. L. (1999). Autonomy, Futility, and the Limits of Medicine. In: H. Kuhse and P. Singer (ed.). Bioethics: An Anthology (pp. 518–52). Oxford: Blackwell.
83.Shelton, W. (1998). A Broader Look at Medical Futility. Theoretical Medicine and Bioethics, 19 (4), 383–400.
84.Smith II, G. P. (1995). Futility and the Principle of Medical Futility: Safeguarding Autonomy and the Prohibition against Cruel and Unusual Punishment. Journal of Contemporary Health Law and Policy, 12 (1), 1–39.
85.Stammers, T. (2015). The Evolution of Autonomy. The New Bioethics, 21 (2), 155–163.
86.Sullivan, S. M. (2007). The Development and Nature of the Ordinary/Extraordinary Means Distinction in the Roman Catholic Tradition. Bioethics, 21 (7), 386–397.
87.Thiroux, J. P. (2004). Ethics: Theory and Practice, 8th edition. Upper Saddle River: Pearson Prentice Hall.
88.Truog, R. D., Brett, A. S., Frader, J. (1992). The Problem with Futility. The New England Journal of Medicine, 326 (23), 1560–1564.
89.UNESCO (2005). Universal Declaration on Bioethics and Human Rights.
91.United States Conference of Catholic Bishops (USCCB) (2009). Ethical and Religious Directives for Catholic Health Care Services, 5th edition.
93.Veatch, R. M. (1972). Models for Ethical Medicine in a Revolutionary Age. The Hastings Center Report, 2 (3), 5–7.
94.Veatch, R. M. (1995). Resolving Conflicts among Principles: Ranking, Balancing, and Specifying. Kennedy Institute of Ethics Journal, 5 (3), 199–218.
95.Veatch, R. M. (2012). The Basics of Bioethics, 3rd edition. Boston: Pearson.
96.Wildes, K. W. (1996). Ordinary and Extraordinary Means and the Quality of Life. Theological Studies, 57 (3), 500–-512.
97.Zientek, D. M. (2006). The Impact of Roman Catholic Moral Theology on End-of-Life Care Under the Texas Advance Directives Act. Christian Bioethics, 12 (1), 65–82.