CHAPTER 6
Medical Decisions at the End of Life

Introduction

Ending a human life may be the most momentous decision one could ever make. This decision will depend largely on what death means to us. Until the second half of the twentieth century, death was defined in relatively simple terms. A person who ceased to breathe and whose heart stopped beating was declared dead. But the use of the mechanical ventilator in the late 1960s and early 1970s forced a change in the cardiopulmonary definition and diagnosis of death. This new technology made it possible to sustain breathing and heartbeat, even when the brain stem controlling these processes had ceased to function. Mechanical ventilation, cardiopulmonary resuscitation (CPR), artificial hydration and nutrition, and drugs that could sustain blood pressure enabled medical professionals to extend lives that would have ended without these interventions. Early on, however, it became evident that these interventions could have undesirable and indeed tragic consequences.

One of these consequences was the case of Karen Ann Quinlan. In April 1975, this twenty-one-year-old woman arrived comatose at a New Jersey hospital after ingesting drugs and alcohol. She was put on a respirator to assist her breathing, but gradually fell into a persistent vegetative state (PVS). Individuals in such a state are wakeful but not consciously aware of their surroundings. Karen';s

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Biomedical Ethics
Table of contents

Table of contents

  • Title Page iii
  • Contents vii
  • Preface ix
  • Biomedical Ethics xi
  • Chapter 1 - History and Theories 1
  • Chapter 2 - The Patient-Doctor Relationship 23
  • Chapter 3 - Medical Research on Humans 47
  • Chapter 4 - Reproductive Rights and Technologies 71
  • Chapter 5 - Genetics 95
  • Chapter 6 - Medical Decisions at the End of Life 119
  • Chapter 7 - Allocating Scarce Medical Resources 143
  • Index 167
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