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February 23, 2000

Decisions to Withdraw Life-Sustaining Treatment: A Moral Algorithm

Author Affiliations

Author Affiliation: Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC.


Controversies Section Editor: Phil B. Fontanarosa, MD, Deputy Editor.

JAMA. 2000;283(8):1065-1067. doi:10.1001/jama.283.8.1065

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clinical state is seriously deteriorating and if, and under which conditions, life support may ethically be withheld or withdrawn from them.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.