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Withholding or Withdrawing Treatment

Fred Rosner, MD
Arch Intern Med. 1987;147(1):180. doi:10.1001/archinte.1987.00370010177043.
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To the Editor.  —I strongly disagree with the position of the American Medical Association's Council on Ethical and Judicial Affairs that, under certain very limited circumstances, "it is not unethical to discontinue all means of life-prolonging medical treatment" and that "life-prolonging medical treatment includes medication and artificially or technologically supplied respiration, nutrition, or hydration."1A decade ago, the New Jersey Supreme Court authorized the removal of Karen Ann Quinlan's respirator. When asked whether he wanted intravenous feedings stopped, Quinlan's father expressed amazement saying: "Oh no, that is her nourishment," clearly making a sharp distinction between the intravenous line and the respirator.2 What has changed the perception of society and the medical profession that nutrition and hydration by intravenous lines or nasogastric tubes are not medical treatment, but supportive care no different than skin care, bowel and bladder care, and grooming; that these devices are simple conduits for food


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