title: End-of-life decisions - some international comparisons.
abstract: Healthcare professionals often confront difficult issues in end-of-life care. Caregivers who question futile care and treatment can find themselves at odds with patients, family members and surrogates who stress patient autonomy. Many developed nations recognize hospital ethics committees as appropriate venues for discussion of end-of-life care, and palliative care initiatives in many hospitals play important roles in patient care at the end of life. As health systems worldwide confront diminishing resources and endless questioning on expenditures, the concept of medical futility has taken on increasing prominence. Medical professionals know intuitively that certain interventions near the end of life can neither extend life nor improve the quality of life remaining. In addition to medical futility, concerns about international economic pressures and enhanced recognition of patient autonomy lead to questions as to the appropriateness of withdrawing life-sustaining treatment, assisted suicide and euthanasia. While some appellate courts seem willing to entertain questions on the legal rights of patients to access certain end-of-life measures, legislative bodies appear reluctant to legalize assisted suicide and euthanasia.
authors.affiliation: Consultant, Moses Taylor Foundation, and Adjunct Professor, The University of Scranton, Scranton, Pennsylvania, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Costello
authors.affiliation: Professor and Chairman, Department of Health Administration & Human Resources, The University of Scranton, Pennsylvania, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: West
authors.affiliation: Assistant Professor, Health Services Administration Program, Department of Health Management & Informatics, College of Health & Public Affairs, University of Central Florida, Florida, USA.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Ramirez
mesh_terms: D017028:Caregivers / Q000523:psychology; D003431:Cross-Cultural Comparison; D019049:Developed Countries; D006801:Humans; D018447:Medical Futility / Q000941:ethics* / Q000523:psychology*; D026684:Personal Autonomy; D011788:Quality of Life; D013727:Terminal Care / Q000191:economics / Q000941:ethics* / Q000523:psychology*