Life-sustaining therapy and dignified death. Myths and realities.

The use of a variety of diagnostic and therapeutic procedures made availabl e by modern technology for critical patients have given rise to forms of de ath which are incompatible with a person's dignity in cases in which the in evitable occurrence of death is inexplicably delayed. The search for the mu ltiple factors influencing this phenomenon, related to the development and progress of medicine, leads to the investigation of four aspects deemed ess ential in their determination: imperative technology, sanctity of life, omn ipotence of medicine and the lack of a unique medical decision. Apart from the availability of high technology, there is an increasing requirement of the patient's full autonomy with respect to the decisions involving the end of his life, which include the debated right to die. In the struggle towar ds death with dignity in a context where practical decisions are required, the following are taken into account: refusal of treatment, irreversibility of clinical diagnosis and palliative support, and withholding and withdraw al of life-sustaining therapy.