A Good Death

摘要

Congratulations to Ben Mitchell, the Ethics & Medicine staff, and the Editorial Board for putting together this fascicle. The ethical dilemmas presented at the end of life are increasingly frequent and complex. At least two factors contribute: First, the dramatic developments of medicine over the past three decades have significantly decreased the incidence of sudden death in developed countries. We now have a national 911 system ready to summon advanced life support ambulances staffed by excellently trained emergency medical teams and portable defibrillators. They transport the critically ill to hospitals where teams are waiting to do emergency angioplasties, offer trauma units, and have ICU's to preserve the life of the critically ill. As a result many who formerly would have died suddenly are now dying gradually of other diseases; many at an advanced age.1 Sudden death does, after all, avoid many ethical ambiguities. Gradual death raises more ethical challenges. Second, we have new life sustaining technologies becoming available at an unprecedented rate. It is rare for people to come to the end of life today without some decision to limit care. One study showed that 90% of ICU deaths came only after such a decision.2 Each of these decisions is replete with ethical implications and, consciously or not, is founded on a set of ethical presuppositions. With somewhere around 10,000 souls dying each day in the United States alone, the sheer numbers of these ethical dilemmas are legion when compared to other areas of interest to Bioethics and to this journal. Ethics & Medicine is, indeed, well to devote this entire fascicle to end of life issues.