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April 1985

Limiting Treatment in a Social Vacuum: A Greek Chorus for William T.

Author Affiliations

From the Department of Preventive, Family and Rehabilitation Medicine, University of Rochester (NY) School of Medicine and Dentistry.

Arch Intern Med. 1985;145(4):716-719. doi:10.1001/archinte.1985.00360040150032

Decisions about the fate of irreversibly incompetent patients, troubling even in the absence of financial constraints, pose problems that are larger than simply medical or legal and require broader social attention. These decisions depend on a social and individual history to which the patient's family and friends customarily offer a guide. But who supplies the answers when the patient, suddenly incompetent, exists in a social vacuum, without friends or family or recorded wishes? It is still necessary to decide how the abstract principles of law and ethics are to be applied in a particular case; with increasing pressure not to spend money needlessly, medicine stands in need of a process or ritual that will preserve the physician-patient relationship and protect both parties from arbitrarily applied rules.

THE CASE OF WILLIAM T.  William T. was a sadly ordinary patient whose case illustrates the difficulties of determining the care to be given