Evolving Consensus Statements in Bioethics

§        The goals of medical care are to cure disease, restore function, eliminate suffering, and prevent illness.

§        The competent and informed patient has the right to refuse any form of treatment, regardless of whether he or she is terminally ill.

§        If a patient is to give informed consent or refusal to treatment, he or she must have decision making capacity, must have the information about the treatment that a reasonable person would need to have to make a decision, must be able to comprehend the information, must know treatment alternatives and the risks and benefits of all treatment options, must know the implications of refusing all treatment, and must be able to act without coercion.

§        For a patient to have decision making capacity, he or she must be able to understand the need for treatment, the information given about treatment alternatives and the implications of receiving or refusing treatment, and must have the ability to relate that information to personal values and then to communicate a decision.

§        A diagnosis of mental illness does not by itself justify a judgment that the patient lacks decision making capacity.

§        The physician has a duty to recommend the course of treatment that is in his or her judgment reflects the patient's best interests.

§        When a patient refuses treatment, the physician should understand the patient's reasons for refusing treatment (even though he or she need not agree with those reasons), especially if the refusal will, in the physician's judgment, lead to serious consequences for the patient.

§        If a patient lacks decision making capacity, a family member or significant other may act as the patient's surrogate.

§        If a patient's wishes about treatment are known, they should be followed; if they are not known, an attempt should be made to determine what the patient would probably have wanted.  If that cannot be determined, the decision should be based on the patient's best interests as perceived by family and physician.

§        A best interests standard does not attempt to assess what the patient wants but rather, from an objective perspective, tries to weigh burdens of treatment and continued life against benefits of treatment and continued life. Any quality of life consideration, however, is to be assessed from the patient's perspective (for example, the patient's perceived experience of burden and benefit).

§        Parents have a right and a duty to make treatment decisions for their children and may be presumed to be acting in their child's best interests.  However, it is generally inappropriate to forgo a child's life sustaining treatment if refusal is based solely on the child's physical or mental handicaps. Decisions should reflect the child's best interests rather than the family's.

§        Similar cases should be treated similarly.

§        There is a psychological difference but no moral difference between withholding and withdrawing treatment under the same circumstances. It is more reasonable to try a treatment and then stop if the treatment does not achieve the patient's desired goal than to withhold the treatment on the grounds that it might not achieve the patient's desired goal.

§        Treatment recommendations should clearly articulate the goals of treatment so that patients/surrogates can be clear as to whether treatment meets their desired goals.

§        Advance directives are helpful in encouraging dialogue among patient, family, and physician about the patient's values and preferences with respect to treatment until such time as they are no longer able to make decisions. Such discussions should not depend on characterizations such as "heroic" or "extraordinary" or "ordinary" treatment because these terms are not amenable to specific definition. Written directives are not ethically more important than oral directives.

§        Rationing decisions should not be made by individual physicians for individual patients. The rationing of health care (decisions about limiting availability of medical care to individual patients) should be explicitly addressed at the policy level, whether at the institutional, professional, or governmental level.

§        Patients may want to use economic factors in making their own decisions, but surrogates' use of economic factors in making decisions for others is controversial.

Ross, Judith W, et al. Health Care Ethics Committees-The Next Generation. American Hospital Publishing, Inc. 1993: Chapter 5, pages 47-48.

*** The above consensus statements are provided for educational purposes and do not reflect specific policy statements of Wake Forest University Baptist Medical Center.