MEDICAL-ETHICS - WHEN TO STOP TREATMENT

Several misunderstandings regarding the question of when to stop treat ment are examined by considering two frameworks for sorting out the di fferent dimensions of the question. One framework addresses what is me ant, and what is not meant, by 'stopping treatment'. The other plots v arious strategies of stopping treatment on a continuum of increasing d egrees of invasiveness. While significant disagreements remain at impo rtant points, there is evidence of an emerging consensus in Western me dicine: (1) that palliative care and counselling through the dying pro cess should be increased whenever curative or life-sustaining treatmen t is curtailed; (ii) that any treatment that is not curative, but mere ly life-sustaining, should be stopped whenever a patient makes an auth entic request to have it stopped; (iii) that genuinely futile treatmen t should not be offered even if requested; (iv) that much more thought and discussion is required to achieve a workable agreement about the definitions of 'futile' and 'inappropriate' treatment; and (v) that as sistance in dying, although profoundly problematic, is no longer unthi nkable.