Featured Research

from universities, journals, and other organizations

Reasoning through the rationing of end-of-life care

Date:
January 21, 2010
Source:
Johns Hopkins Medical Institutions
Summary:
Acknowledging that the idea of rationing health care, particularly at the end of life, may incite too much vitriol to get much rational consideration, a professor of neurology called for the start of a discussion.

Acknowledging that the idea of rationing health care, particularly at the end of life, may incite too much vitriol to get much rational consideration, a Johns Hopkins emeritus professor of neurology called for the start of a discussion anyway, with an opinion piece featured in this month's issue of the Journal of Medical Ethics.

In the January article, John Freeman, M.D., Lederer Professor Emeritus of Pediatric Neurology and a faculty member of the Johns Hopkins Berman Institute of Bioethics, asks the Obama administration to consider rationing end-of-life care as an initial step towards healthcare reform.

The article starts with the premise that futile and expensive care at the end of life is widespread, that it has been a major contributor to the increasingly unaffordable cost of healthcare and that the nation is unable to provide it equitably to all.

He goes on to say that while administering such care -- as ordered through a living will, next of kin or parent -- should be respected, he advocates that the ethical imperatives of "patient autonomy" and "surrogate autonomy" (passing responsibility for decision-making to next of kin when a patient no longer is competent to make his own decisions) should be weighed against the societal impact and costs of such care in futile circumstances.

"Perhaps when surrogate autonomy and the ethical principles of beneficence" -- the duty to do more good than harm -- "compete with the utilitarian principle of doing the greatest good for society, the family be given a 'nudge' towards comfort care only," Freeman suggests in the piece.

"There must be few situations more undignified, more dehumanizing or more humiliating than lying in bed, incontinent, tube fed, with or without a respirator, unable to speak or to relate to individuals or the environment," Freeman says, factors that more surrogates may want to give more weight.

Rationing and providing only comfort care should be considered not just at the end of life for adults, Freeman maintains, but also in instances of extremely premature births. He cites studies showing that intensive care for infants born at 22-23 weeks resulted in more than 1,700 extra days in intensive care, with less than 20 percent surviving. Of those 20 percent, less than 3 percent survived without profound impairment that required expensive interventions.


Story Source:

The above story is based on materials provided by Johns Hopkins Medical Institutions. Note: Materials may be edited for content and length.


Journal Reference:

  1. Freeman et al. Rights, respect for dignity and end-of-life care: time for a change in the concept of informed consent. Journal of Medical Ethics, 2010; 36 (1): 61 DOI: 10.1136/jme.2009.031773

Cite This Page:

Johns Hopkins Medical Institutions. "Reasoning through the rationing of end-of-life care." ScienceDaily. ScienceDaily, 21 January 2010. <www.sciencedaily.com/releases/2010/01/100119172802.htm>.
Johns Hopkins Medical Institutions. (2010, January 21). Reasoning through the rationing of end-of-life care. ScienceDaily. Retrieved September 1, 2014 from www.sciencedaily.com/releases/2010/01/100119172802.htm
Johns Hopkins Medical Institutions. "Reasoning through the rationing of end-of-life care." ScienceDaily. www.sciencedaily.com/releases/2010/01/100119172802.htm (accessed September 1, 2014).

Share This




More Health & Medicine News

Monday, September 1, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

We've Got Mites Living In Our Faces And So Do You

We've Got Mites Living In Our Faces And So Do You

Newsy (Aug. 30, 2014) A new study suggests 100 percent of adult humans (those over 18 years of age) have Demodex mites living in their faces. Video provided by Newsy
Powered by NewsLook.com
Liberia Continues Fight Against Ebola

Liberia Continues Fight Against Ebola

AFP (Aug. 30, 2014) Authorities in Liberia try to stem the spread of the Ebola epidemic by raising awareness and setting up sanitation units for people to wash their hands. Duration: 00:41 Video provided by AFP
Powered by NewsLook.com
California Passes 'yes-Means-Yes' Campus Sexual Assault Bill

California Passes 'yes-Means-Yes' Campus Sexual Assault Bill

Reuters - US Online Video (Aug. 30, 2014) California lawmakers pass a bill requiring universities to adopt "affirmative consent" language in their definitions of consensual sex, part of a nationwide drive to curb sexual assault on campuses. Linda So reports. Video provided by Reuters
Powered by NewsLook.com
New Drug Could Reduce Cardiovascular Deaths

New Drug Could Reduce Cardiovascular Deaths

Newsy (Aug. 30, 2014) The new drug from Novartis could reduce cardiovascular deaths by 20 percent compared to other similar drugs. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins