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| | | The ethics of non-treatment decisions (NTDs) | | | | L.J. Materstvedt1 | | 1Norwegian University of Science and Technology (NTNU), Department of Philosophy, Trondheim, Norway | | | | Not initiating (withholding) or discontinuing (withdrawing) futile treatment are both "non-treatment decisions" (NTDs). A commonly accepted definition of "futile treatment" is given. The area of NTDs is however wider than that of futile treatment since it includes situations in which treatment is effective but is considered disproportionate. From an ethical point of view, the latter is not unproblematic and some examples are provided. But nor is so-called futile treatment ethically unproblematic, even though it is regularly thought to be. One issue is whether futile treatment can ever be justified and this paper argues that it can. Recently, the notion of "palliative futility" has been introduced. In this presentation, this concept is rejected as a misnomer and it is also shown that it fails to mirror clinical reality. Other issues addressed are: Do physicians intend death when carrying out NTDs, or do they merely wish for death to come sooner rather than later? What is the difference, if any, between an intention and a wish? There is a practical-clinical difference between euthanasia (lethal injection by a doctor at the patient's voluntary and competent request) and NTDs, yet the outcome (immediate death) may sometimes be similar. Does this factual difference also amount to an ethical difference? Is it, in the language of ethical theory, a difference that makes a difference or are both instances simply cases of medicalised killing albeit at different levels? | | |
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