Ethics Opinions

Physicians are not required to offer or to provide interventions that, in their best medical judgment, cannot reasonably be expected to yield the intended clinical benefit or achieve agreed-on goals for care. Respecting patient autonomy does not mean that patients should receive specific interventions simply because they (or their surrogates) request them.

When a terminally ill patient experiences severe pain or other distressing clinical symptoms that do not respond to aggressive, symptom-specific palliation, it can be appropriate to offer sedation to unconsciousness as an intervention of last resort.

Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Instead of engaging in assisted suicide, physicians must respond to the needs of patients at the end of life.

Euthanasia is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Euthanasia could readily be extended to incompetent patients and other vulnerable populations. Instead of engaging in euthanasia, physicians must respond to the needs of patients at the end of life.

Physicians have clinical ethical responsibilities to address the pain and suffering occasioned by illness and injury, requiring physicians to ensure the provision of effective palliative care regardless of prognosis. Palliative care is sound medical treatment that is patient-centered with additional focus on the needs, values, beliefs, and culture of patients and those who love and care for them in decision-making accordingly.

Donation of nonvital organs and tissue from living donors can increase the supply of organs available for transplantation, to the benefit of patients with end-stage organ failure. Enabling individuals to donate nonvital organs is in keeping with the goals of treating illness and relieving suffering so long as the benefits to both donor and recipient outweigh the risks to both.

Physicians should support innovative approaches to increasing the supply of organs for transplantation but must balance this obligation with their duty to protect the interests of their individual patients. Organ donation after cardiac death is one approach being undertaken to make greater numbers of transplantable organs available.

Offering financial incentives for donation raises ethical concerns about potential coercion, the voluntariness of decisions to donate, and possible adverse consequences, including reducing the rate of altruistic organ donation and unduly encouraging perception of the human body as a source of profit. These concerns merit further study to determine whether, overall, the benefits of financial incentives for organ donation outweigh their potential harms.

Donations under presumed consent (or mandated choice) would be ethically appropriate only if it could be determined that individuals were aware of the presumption that they were willing to donate organs and if effective and easily accessible mechanisms for documenting and honoring refusals to donate had been established.

Transplants of umbilical cord blood have been recommended to treat a variety of conditions. Physicians who provide obstetrical care should be prepared to inform pregnant women of the various options regarding cord blood donation or storage and the potential uses of donated samples.