It frequently seems reasonable to institute aggressive treatment for a sufficient time to see if the disease will respond. As physicians, we are prepared to apply life sustaining technology to patients when the benefit seems to outweigh the risk and when there is a reasonable chance for an outcome that the patient would desire. If, however, organ system failure is not reversible, the reasoning behind life support technology becomes moot, and they serve no further useful function. We must then be prepared to remove supportive technology when it appears in our best judgment that inevitable death is being prolonged rather than meaningful life. Accordingly, a controversy has arisen paralleling the rise of life supporting technology.
Physicians normally decide when to apply such therapy.
Increasingly the patients and their families are becoming more aggressive in deciding when to remove them. In American society, where rights of the individual are traditionally favored over that of masses, the courts have repeatedly affirmed competent a patient's authority to regulate their medical treatment, regardless of their reasoning. However, when the patient becomes incapacitated, family surrogates are usually granted virtually power to dictate treatment options because of their proximate knowledge of what the patient would have wanted before they became incompetent. This position is based on the postulation that any attempt to interject outside paternalism into the surrogate decision making equation is ethically unacceptable. Logically, rational patients and their families should not be willing to continue life support after a reasonable trial has demonstrated their benefit has passed the point of diminishing returns.