The Ethical Standard for End-of-Life Decisions for Unrepresented Patients.

Matthew Shea
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Abstract

There has been increasing awareness of the medical and moral challenges in the care of unrepresented patients: those who cannot make their own medical decisions, do not have any surrogate decision maker, and have not indicated their treatment preferences. Most discussions have focused on procedural questions such as who should make decisions for these patients. An issue that has not gotten enough attention is the ethical standard that should govern medical decision making. I explore the question of which ethical standard provides better justification for end-of-life decisions for unrepresented patients. Two options are considered: the conventional and less demanding best interest standard, and the novel and more demanding medical futility standard. I explain the similarities and differences between these two standards, examine arguments for and against each one, and suggest that the medical futility standard is ethically superior and should replace the established best interest standard.
为无代表病人做出生命终结决定的道德标准。
越来越多的人意识到为无代表病人提供医疗服务所面临的医疗和道德挑战:这些病人无法做出自己的医疗决定,没有任何代理决策者,也没有表明自己的治疗偏好。大多数讨论都集中在程序问题上,比如谁应该为这些病人做决定。一个尚未引起足够重视的问题是,医疗决策应遵循什么样的伦理标准。我探讨的问题是,哪种伦理标准能更好地为无代表病人的临终决定提供正当理由。我考虑了两种选择:一种是传统的、要求较低的最佳利益标准,另一种是新颖的、要求较高的医疗无效标准。我解释了这两种标准的异同,研究了支持和反对这两种标准的论据,并提出医疗无效标准在伦理上更优越,应取代既定的最佳利益标准。
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