Institutional Protocols for Decisions About Life-Sustaining Treatments. Special Report

摘要

The special report extends the analysis provided in OTA's 1987 assessment of Life-Sustaining Technologies and the Elderly. That report documented the numerous, serious uncertainties that complicate inherently difficult decisions about the use of medical technologies that are potentially life-sustaining. OTA described uncertainties regarding: (1) outcomes of treatment-whether the patient will survive and, if so, with what quality of life; (2) circumstances in which nontreatment may be ethical and legal; and (3) decisionmaking procedures-whose judgment to seek, for what, and when, and how to resolve conflicts and ensure that a decision, once reached, is carried out. To help reduce these various sources of uncertainty and their serious consequences, OTA suggested a variety of actions Congress might take. One of these was to focus on the policies and guidelines by which health care institutions circumscribe and articulate the procedures they will follow in making decisions whether to initiate, withhold, or withdraw life-sustaining treatments.