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This paper examines how decisions to limit treatment to critically ill patients under uncertainty can be made rationally. Expected utility theory offers one way of making rational decisions under uncertainty. One problem with using this approach is that we may not know the value of each option. One rational course open is to treat until further information becomes available. However, treatment can limit the range of options open. With treatment, a patient may recover such that he no longer requires life-supporting treatment. However, his life may be not worth living. If active euthanasia of 'non-terminal' conditions is prohibited, the option of dying will no longer be available. Taking a rational 'wait and see' course may result in being trapped within an unbearable life. On the other hand, sometimes present practice 'lets nature take its course'. Critically ill patients are allowed to die because it is believed that their lives will be not worth living. It is likely that some patients are allowed to die when there is some objective chance of worthwhile future life. This paper argues that a policy of treating critically ill patients until the nature of future options can be better evaluated, in company with an offer of subsequent euthanasia where appropriate, allows a more rational and humane approach to treatment limitation decisions under uncertainty.

Type

Journal article

Journal

Bioethics

Publication Date

01/1994

Volume

8

Pages

49 - 73

Keywords

Analytical Approach, Death and Euthanasia, Computers, Critical Illness, Decision Making, Decision Support Techniques, Ethics, Euthanasia, Euthanasia, Active, Euthanasia, Passive, Evaluation Studies as Topic, Freedom, Health Care Rationing, Humans, Life Support Care, Medical Futility, Mental Competency, Patient Selection, Persistent Vegetative State, Personal Autonomy, Policy Making, Probability, Prognosis, Quality of Life, Quality-Adjusted Life Years, Reference Standards, Resuscitation, Right to Die, Risk, Social Values, Statistics as Topic, Stress, Psychological, Treatment Outcome, Uncertainty, Value of Life, Withholding Treatment, Wounds and Injuries, Wrongful Life