Author Affiliation: Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC.
Controversies Section Editor: Phil B. Fontanarosa,
MD, Deputy Editor.
The practical ethical question in the case of Reverend G is this: when,
if ever, and under which conditions, can his cardiac pacemaker be removed?
This is a specific instance of the more generic question of how vigorously
physicians are bound to preserve life in patients whose clinical state is
seriously deteriorating and if, and under which conditions, life support may
ethically be withheld or withdrawn from them. These are the most common ethical
questions confronting clinicians at the bedside today. Every clinician is
obliged to make these decisions in a morally defensible way. To do so requires
some understanding of the moral anatomy of ethical decisions. This article
undertakes to expose something of that anatomy as it is revealed in the case
of Reverend G.
Pellegrino ED. Decisions to Withdraw Life-Sustaining TreatmentA Moral Algorithm. JAMA. 2000;283(8):1065-1067. doi:10.1001/jama.283.8.1065