Editing Life support (section)

==Bioethics==
As technology continues to advance within the medical field, so do the options available for healthcare. Out of respect for the patient's autonomy, patients and their families are able to make their own decisions about life-sustaining treatment or whether to hasten death.<ref>Beauchamp, Tom L., [[LeRoy Walters]], Jefferey P. Kahn, and Anna C. Mastroianni. "Death and Dying." Contemporary Issues in Bioethics. Wadsworth: Cengage Learning, 2008. 397. Web. 9 Nov. 2013.</ref> When patients and their families are forced to make decisions concerning life support as a form of end-of-life or emergency treatment, ethical dilemmas often arise. When a patient is terminally ill or seriously injured, medical interventions can save or prolong the life of the patient. Because such treatment is available, families are often faced with the moral question of whether or not to treat the patient. Much of the struggle concerns the ethics of letting someone die when they can be kept alive versus keeping someone alive, possibly without their consent.<ref>{{Cite web|url=https://www.acls.net/information-and-ethics.htm|title=Life Support: Information and Ethics|website=www.acls.net|access-date=2016-12-01}}</ref> Between 60 and 70% of seriously ill patients will not be able to decide for themselves whether or not they want to limit treatments, including life support measures. This leaves these difficult decisions up to loved ones and family members.

Patients and family members who wish to limit the treatment provided to the patient may complete a [[do not resuscitate]] (DNR) or [[intubate|do not intubate]] (DNI) order with their doctor. These orders state that the patient does not wish to receive these forms of life support. Generally, DNRs and DNIs are justified for patients who might not benefit from CPR, who would result in permanent damage from CPR or patients who have a poor quality of life prior to CPR or [[intubation]] and do not wish to prolong the dying process.

Another type of life support that presents ethical arguments is the placement of a feeding tube. Decisions about hydration and nutrition are generally the most ethically challenging when it comes to end-of-life care. In 1990, the [[Supreme Court of the United States|US Supreme Court]] ruled that [[Feeding tube|artificial nutrition]] and hydration are not different from other life-supporting treatments. Because of this, artificial nutrition and hydration can be refused by a patient or their family. A person cannot live without food and water, and because of this, it has been argued that withholding food and water is similar to the act of killing the patient or even allowing the person to die.<ref>Abbot-Penny A, Bartels P, Paul B, Rawles L, Ward A [2005]. End of Life Care: An Ethical Overview. Ethical Challenges in End of Life Care. [Internet]. [cited 2013 Nov 6]. Available from: www.ahc.umn.edu/img/assets/26104/End_of_Life.pdf life support bioethics</ref> This type of voluntary death is referred to as [[passive euthanasia]].<ref>Beauchamp, Tom L., LeRoy Walters, Jefferey P. Kahn, and Anna C. Mastroianni. "Death and Dying." Contemporary Issues in Bioethics. Wadsworth: Cengage Learning, 2008. 402. Web. 9 Nov. 2013.</ref>

In addition to patients and their families, doctors also are confronted with ethical questions. In addition to patient life, doctors have to consider medical resource allocations. They have to decide whether one patient is a worthwhile investment of limited resources versus another.<ref>{{Cite web|url=https://www.acls.net/information-and-ethics.htm|title=Life Support: Information and Ethics|website=www.acls.net|access-date=2016-12-01}}</ref> Current ethical guidelines are vague since they center on moral issues of ending medical care but disregard discrepancies between those who understand possible treatments and how the patient's wishes are understood and integrated into the final decision. Physicians often ignore treatments they deem ineffective, causing them to make more decisions without consulting the patient or representatives. However, when they decide against medical treatment, they must keep the patient or representatives informed even if they discourage continued life support. Whether the physician decides to continue to terminate life support therapy depends on their own ethical beliefs. These beliefs concern the patient's independence, consent, and the efficacy and value of continued life support.<ref>{{Cite journal|last=Gedge|first=E|last2=Giacomini|first2=M|last3=Cook|first3=D|date=2016-12-01|title=Withholding and withdrawing life support in critical care settings: ethical issues concerning consent|journal=Journal of Medical Ethics|volume=33|issue=4|pages=215–218|doi=10.1136/jme.2006.017038|issn=0306-6800|pmc=2652778|pmid=17400619}}</ref> In a prospective study conducted by T J Predergast and J M Luce from 1987 to 1993, when physicians recommended withholding or withdrawing life support, 90% of the patients agreed to the suggestion and only 4% refused. When the patient disagreed with the physician, the doctor complied and continued support with one exception. If the doctor believed the patient was hopelessly ill, they did not fulfill the surrogate's request for resuscitation.<ref>{{Cite journal|last=Prendergast|first=T J|last2=Luce|first2=J M|title=Increasing incidence of withholding and withdrawal of life support from the critically ill.|journal=American Journal of Respiratory and Critical Care Medicine|volume=155|issue=1|pages=15–20|doi=10.1164/ajrccm.155.1.9001282|pmid=9001282|year=1997}}</ref> In a survey conducted by Jean-Louis Vincent MD, PhD in 1999, it was found that of European intensivists working in the Intensive Care Unit, 93% of physicians occasionally withhold treatment from those they considered hopeless. Withdrawal of treatment was less common. For these patients, 40% of the physicians gave large doses of drugs until the patient died. All of the physicians were members of the European Society of Intensive Care Medicine.<ref>{{Cite journal|title= Forgoing life support in western European intensive care units|journal=Critical Care Medicine|volume=27|issue=8|pages=1626–33|date=August 1999|last1=Vincent|first1=Jean-Louis|doi=10.1097/00003246-199908000-00042|pmid=10470775}}</ref>