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ARTICLE |

Decisions to Abate Life-Sustaining Treatment for Nonautonomous Patients:  Ethical Standards and Legal Liability for Physicians After Cruzan

Robert F. Weir, PhD; Larry Gostin, JD
JAMA. 1990;264(14):1846-1853. doi:10.1001/jama.1990.03450140068036.
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PHYSICIANS often feel impelled to initiate and continue the complete range of modern medical procedures to prolong the lives of critically ill patients. A tragic consequence is that patients who lack decision-making capacity are sometimes given life-sustaining treatment that is not consistent with the patients' previous preferences, not in the patients' best interests, and not wanted by their families.

Why are such cases sometimes handled this way? The reasons are multiple. First, cases involving adult patients who lack decision-making capacity often have medical and nonmedical uncertainties not commonly present in other cases. Some of the uncertainty concerns the questionable decision-making status of patients who have a diminished or fluctuating capacity to make health care decisions because of shock, mental illness, clinical depression, or organic brain syndrome. Other problems arise in cases with patients who have a substantial incapacity to make decisions because of mental retardation, brain damage, severe dementia, or

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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