Only in rare and narrow circumstances does U.S. law permit
clinicians to stop life-sustaining treatment WITHOUT the consent of the patient or surrogate. Therefore, the focus of many policies and guidelines is on getting that consent.
Unfortunately, that consent is often not informed or voluntary. I have written about this before (for example, here and here).
Yesterday, in the Detroit Free Press David Blumenthal discusses how some physicians refer to themselves as "The Grim Reaper” “Oh, just give me 10 minutes with the family, I’ll convince them to pull the plug.”
Blumenthal observes that "the situation worsens when, often for cultural or religious reasons, families decide to continue aggressive care for their loved ones even after achieving a better understanding of the prognosis and painful course of illness. In these cases, the doctor, conditioned to hammer home the bad news expecting the family to eventually relent becomes, ultimately, callous."
"Because large medical teams rotate weekly, they often each feel the need to encourage reducing treatment, frequently ignoring families who I’ve seen plead for the subject not to be brought up again."
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