Principles for making moral medical decisions

1. No matter what life-sustaining procedure/medical treatment is in question, when in doubt, err on the side of life. You can always try an intervention with the option of stopping it if it proves ineffective or excessively burdensome for the patient.

2. It is the physician’s obligation to truthfully and fully, in layperson’s terms, discuss with the patient/agent/family/guardian the benefits, risks, cost, etc. of all available medical means that may improve the patient’s condition or prolong life. The focus should be on what the person making medical decisions needs to know in order to give truly informed consent.

3. The patient/agent makes the decision whether or not a particular treatment is too burdensome. If the patient wishes to fight for every last moment of life, it is his/her right to receive/continue treatment and care that might extend life.

4. It is impossible to make morally sound, sensible, informed health care decisions based on guesswork about some future illness or injury/treatment options. Health care decisions must be based on current information.

5. Two extremes are to be avoided:

  • Insistence on useless or excessively burdensome treatment even when a patient may legitimately wish to forgo it.
  • Withdrawal or withholding of treatment with the intention to cause death.

6. The object and motive for administering pain medication must be to relieve pain; death must not be sought or intended.

7. Nutrition and hydration, whether a person is fed with a spoon or through a tube, is basic care, not medical treatment. Insertion or surgical implantation of a feeding tube takes medical expertise, but it is an ordinary life-preserving procedure for a person who has a working digestive system but is unable to eat by mouth. Circumstances and intent determine the morality of withholding food and fluids.

  • Acceptable – During the natural dying process, when a person’s organs are shutting down so that the body is no longer able to assimilate food and water or when their administration causes serious complications, stopping tube-feeding or spoon-feeding is both medically and morally appropriate. In these circumstances, the cause of death is the person’s disease or injury, not deliberate dehydration.
  • Unacceptable – When a person is not dying—or not dying quickly enough to suit someone—food and fluids are often withheld with the intent to cause death because the person is viewed as having an unacceptably low quality of life and/or as imposing burdens on others.