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December 27, 1985

Ethical Dilemmas for House Staff Physicians: The Care of Critically III and Dying Patients

Author Affiliations

From the Section of General Medicine, Department of Medicine, University of Pennsylvania, Philadelphia.

JAMA. 1985;254(24):3454-3457. doi:10.1001/jama.1985.03360240066036

THE LIFE-SUSTAINING capability of modern medicine, coupled with its difficult ethical choices, has become the physician's most challenging moral dilemma1-5 (US News and World Report, Dec 6, 1982, p 53; Time, April 9, 1984, p 68). Caring for critically ill and dying patients is a difficult task that often vacillates between the rational and the absurd, the uplifting and the morbid. Conflicts in values among caretakers are frequently present, and uncertainty is pervasive.

This article addresses the issue of distinctive ethical dilemmas faced by residents in caring for critically ill and dying patients, a problem that springs from the increasing capabilities of medicine and the peculiar role of residents in our medical hierarchy. Residents are fully licensed to practice medicine, but they are not totally autonomous. They have heavy responsibilities in patients' care, but they are not independent in making many decisions. They are usually the primary caretakers, but

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