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October 17, 1986

Medical Ethics

JAMA. 1986;256(15):2122-2124. doi:10.1001/jama.1986.03380150132045

From the voluminous literature on the subject of biomedical ethics, three topics will be reviewed: artificial feeding, acquired immunodeficiency syndrome (AIDS), and the physician as "gatekeeper." Each exposes controversies and unsettled ethical issues of urgent interest to health professionals.

Since the Quinlan case, discontinuance of certain life-support measures in permanently comatose patients has received legal and ethical sanction.1-3 In the past year, intensive debate has centered on whether artificial nutrition and hydration are to be classified as medical treatments and also discontinued if futile or burdensome.

Three court cases illustrate the controversial nature of the question and raise new ethical issues. In the Brophy case, the court refused permission to remove a gastrostomy tube on grounds that the patient was not terminal, the tube was not burdensome, and the intent to hasten death was inadmissible.4 The opinion relied on the distinction, which many ethicists reject, between withholding and withdrawing