Ethical Disagreement


(From The Wall Street Journal Dec. 15, 1993):

“Hospital-ethics consultants widely disagree about when to end treatment of unconscious patients who are unlikely to recover.

The disagreements come at a time when more and more patients are being kept alive in a ‘persistent vegetative state’ through new medical technologies, and hospitals are increasingly turning to ethics consultants to help doctors and families decide when, and whether, life-support treatment should be ended.

Ellen Fox, who teaches medical ethics at University of Chicago Hospitals, says that despite this growing trend toward ethics consultations, there’s little evidence that they provide acceptable outcomes. Dr. Fox and a colleague, Carol Stocking, therefore decided to test the advice of 118 ethicists attending a professional meeting in 1991.

The two researchers presented the ethicists with the case of a comatose patient with little chance of recovery, along with eight different vignettes detailing such things as whether the patient or family had indicated a preference for keeping the patient alive.

The researchers gave the ethicists only five possible responses to each vignette. But the respondents disagreed widely on all the suggested outcomes except in one straightforward vignette in which both family and patient had at some time strongly indicated that treatment shouldn’t be prolonged.

Dr. Fox says the study suggests that no right advice exists. She says that instead of imposing personal views, ethicists should ‘delicately orchestrate’ an ethical consensus among participants and help reconcile differences.”

Growing Older

According to the U.S. Census Bureau, the United States is growing older more rapidly than previously thought. New projections for the next half-century, updating projections made just a year ago, increase the expected number of over-85-year-olds in 2020 from 6.5 million to 7 million. This “old-old” group numbered only about 3 million in 1990.

The two principal factors cited by the Census Bureau to explain the increase are advances in medical treatment and changing lifestyles. According to the Bureau’s figures, a 65-year-old in 1990 had an additional life expectancy of 17.2 years; in 1993, that number has increased to 17.6 years.

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