title: The withholding and withdrawal of medical treatment: moral principles and the law #.
abstract: In most hospitals in Puerto Rico the dying process of terminally ill patients is inappropriately prolonged. And this occurs often without the patient's consent and in violation of basic ethical principles. Three erroneous beliefs are prevalent: 1--That withdrawing life support therapy is morally or legally different from not starting it. 2--That there is a moral and legal difference between appropriate acts and appropriate omissions. 3--That good medical practice is determined by the courts instead of the medical profession. Institutional policies are not in harmony with contemporary medical ethics. To avoid possible legal entanglements medical institutions permit their faculties to prolong the suffering of patients in violation of two basic moral principles: nonmaleficence and respect for autonomy. An illustrative case provides a philosopher and a moral theologian the opportunity to analyze the applicable moral principles. A professor of jurisprudence reviews statutes evolved at the State and Federal level that support the rights of patients and their families to refuse unwanted treatments. Medical faculties must ensure that institutional policies do not violate their professional ethics. The medical profession and the citizenry at large should lobby for the passage of statutes in Puerto Rico which clearly validate the necessary harmony between medical ethics and the law.
authors.affiliation: Department of Medicine, Ramón Ruiz Arnau Hospital, Center for Biomedical Humanities, Universidad Central del Caribe.
authors.forename: J
authors.initials: J
authors.lastname: Ramírez Rivera
authors.forename: P A
authors.initials: PA
authors.lastname: Granados
authors.forename: J R
authors.initials: JR
authors.lastname: Echevarría
authors.forename: J
authors.initials: J
authors.lastname: Ferrer
authors.forename: R
authors.initials: R
authors.lastname: Isales
mesh_terms: D000368:Aged; D004992:Ethics, Medical; D006801:Humans; D008297:Male; D018447:Medical Futility; D009014:Morals; D011647:Puerto Rico; D012068:Religion and Medicine; D016414:Resuscitation Orders / Q000331:legislation & jurisprudence; D020458:Third-Party Consent / Q000331:legislation & jurisprudence