Professors Support Right To Die for Terminally Ill

A group of Harvard medical professors and other doctors from around the country have published a new set of guidelines for treatment of patients who are "hopelessly ill," emphasizing that doctors must give patients' wishes preeminence, even should they want to end life-prolonging treatment.

The report, which was the result of a two-day conference at the Medical School last year and which appears in today's issue of the New England Journal of Medicine, addresses the problems faced by doctors who must make ethical decisions about the treatment of terminal patients.

"[The report] is an expression of a growing trend in enlightened medical circles to recognize the patient's right to play an active part in the treatment," said Professor of Health Policy and Management Harvey V. Fineberg '67.

An expert in medical decision making who will become dean of the School of Public Health in July. Fineberg said he has not yet seen the article but said he agrees that patients' wishes are crucial in making such choices.

"It's not a revolutionary idea--it's a step forward. The reason it's important is these doctors who signed it are all leading figures in the medical profession," said one of the authors. Touroff-Glueck Professor of Law and Psychiatry Alan A. Stone '50.

Patients' Rights

He added, "The fact that they're willing to talk about their patient's rights is the big thing."

The issue of patients' wishes as opposed to hospital regulations or doctors' concerns has recently been the subject of national attention.

Colorado Gov. Richard Lamm said in a controversial speech last month that terminally ill people have a duty to die so that society can use its resources to improve people's lives instead of prolonging their deaths.

Call Attention

"What we're trying to call attention to is that our remarkable ability to prolong dying shouldn't automatically be applied," Dr. Daniel D. Federman '49, a professor of medicine and one of the authors of the article, said last night.

"We're not advocating breaking the law, but since the [legal and medical] context is changing, physicians have to make some judgements where the situation is unclear. We're saying they should use a measure of compassion," explained Professor of Radiology Dr. S. James Adelstein, who co-authored the article.

The guidelines set down in the article make two major points, according to Federman. First, the patient's role in the decision-making about treatment should be paramount, and second, doctors should not continue "aggressive treatment" when it would only prolong "a difficult and uncomfortable process of dying."

The issue is complicated by the reluctance of many doctors to do less than everything in their power to prolong or sustain life. Many critics of witholding treatment cite the Hippocratic oath which all doctors take--an oath that requires doctors to do all in their power to preserve life.

But, the authors said, this commitment carries greater implications in an age of advanced medical technologies.

"As technology advances, and becomes capable of extending biological functions--you wouldn't always call it living--we have to rethink (our policy)." Fineberg said.

If a patient is mentally competent and wants to refuse treatment, there is no reason to contrudict their wishes, the doctors said. If a patient is no longer competent, for example sanile, doctors should honor a "living will," or written testament to their wishes, if it was made while they were competent, the article adds.

In case in which there is no written expression of preference, the report siresses the need for doctors to listen to family members opinions on the best course of action. If there is no consensus, the doctors mind make a judgement call, ball the authors of the report say they hope these situation will become increasingly rare.

"This is an effort to try to get doctors to confront this issue, to try to get them to decide (in advance) what their policy should be," Stone said, adding that doctors "need to know what their patients" wishes are--they shouldn't be afraid to talk about them."

Federman added that the authors do not advocate an especially lax approach in cases where the patient's wishes and best interests are not immediately clear.

"If there's any doubt, we agree on the side of going all-out with treatment," he said. And he adds that the recommendations do not apply to any patients other than the terminally ill. "We'd like to see 400 percent treatment for non-terminal patients," he said