Technological development in medicine. Ethical implications of withholding treatment

On Wednesday 21 April 2010, Dr. med. Dorothee Dörr, M.A., Institute for History and Ethics of Medicine at the University of Cologne, spoke about conflicts regarding the assessment of limitations of medical interventions and medical technology at the Medical Ethics Working Group of the Europäische Akademie Bad Neuenahr-Ahrweiler GmbH.

Dörr stated that a therapy should always be examined in respect to its impact on the patient’s survival rate and/or his quality of life. However, the evaluation of quality of life would meet the ethical requirements only if the moral concept of the person concerned was taken into account as the basis for these judgements.

In practice, the limitation of medical treatment was governed by changing the therapy objectives from curative to palliative patient’s care. This would include thoughts about how to practice withholding and withdrawing life-sustaining therapy; focusing on the palliation of suffering – in agreement with the (presumed) patient’s will. A fundamental problem in decision-making would derive from the fact that intervening actively – e. g. terminating mechanical ventilation – was considered as being ethically and legally more troubling by physicians than a passive admitting or wait-and-see position. This required a reflected handling within the issue of limiting the use of technological devices to support human functions. Thus, the terminology of Sterbehilfe categories which were still taken into account both in medicine and in criminal law, would lead to misunderstandings fraught with consequences since it was not in line with clinical reality. Dörr proposed that apart from centering the aim of medical treatment on the quality of life, the discussion about parameters of the quality of dying, in particular in the field of intensive care, had to be dealt with adequately.