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February 3, 1989

Decisions to Limit Care

Author Affiliations

University of Pittsburgh School of Medicine

University of Pittsburgh School of Medicine

JAMA. 1989;261(5):698. doi:10.1001/jama.1989.03420050046023

To the Editor. —  I read with great interest and appreciation the several articles presenting ethical issues in the Aug 12 issue1-3 and the accompanying editorial.4 As an intensivist, I am frequently faced with the issue of withdrawal of therapy. The complexity of these decisions is well illustrated by Dr Brennan1 in his review of the experience at Massachusetts General Hospital. I find most troubling those decisions to limit therapy and withdraw support in the face of a family's request for continued care, classified as type 5 by Dr Brennan.The issues that need to be resolved are, first, who should decide what is good for the patient, and second, the certainty of the prognosis. Beneficence is a nebulous concept, the definition of which will vary among individuals—patient, family, physician, hospital administrator, and society. Similarly, there is no uniform presentation of a "rational patient's wishes" nor agreement