Life-sustaining treatment: when should it be withheld or withdrawn?/Yasami destekleyen tedaviler: ne zaman esirgenmeli? Ne zaman sonlandirilmali?

• Published in: Türk onkoloji dergisi 2012-03, Vol.27 (1), p.37
• Main Authors: Akpinar, Aslihan, Ersoy, Nermin
• Format: Article
• Language: Turkish
• ISSN: 1300-7467
• DOI: 10.5505/tjoncol.2012.540

The development of new life-sustaining treatments may result in lives with questionable life quality or may sometimes extend the duration of death. Under these circumstances, patients, their relatives and/or the healthcare professionals are faced with decisions about life-sustaining treatments. There are two forms of decisions regarding life-sustaining treatment limitation, which are ethically coequal: withholding and withdrawing treatments. The decision can be made by the patient in the presence of decision-making capacity or by a suitable proxy, or the patient may have made a living will prior to the loss of their decision-making capacity. However, it is not always possible to know the patient's wishes, and in such circumstances, it is the healthcare professional(s)' responsibility to decide. The aim of this paper is to discuss the ethical reasoning for limiting life-sustaining treatment in the context of refusal, living will, principle of proportionality, quality of life, treatment futility, and triage. Key words: Ethics, medical; withholding treatment; withdrawing treatment; medical futility; quality of life. Gelisen yasami destekleyen tedavi teknolojileri ile saglanan tibbin yasami uzatma gucu, kalitesi sorgulanabilir yasamlarin hatta bazen olum surecinin uzatilmasina neden olabilmektedir. Bunun sonucunda hasta, ailesi veya saglik calisani tarafindan yasam desteginin sinirlandirilmasi karari verilmesi gerekebilmektedir. Yasam desteginin sinirlandirilmasi etik acidan farksiz olan tedavileri esirgeme veya sonlandirma seklinde gerceklesir. Karar, karar verme yeterligine sahip olan hasta ya da uygun vekil karar verici tarafindan verilebilecegi gibi; hasta, karar verme kapasitesini kaybetmeden once yasayan dilek birakmis olabilir. Her zaman hastanin kararlarini bilmek mumkun degildir. Boyle durumlarda tedaviyi sonlandirma ya da esirgeme kararlarinin saglik calisanlari tarafindan verilmesi gerekir. Bu makalenin amaci yasam desteginin reddi, yasayan dilek, orantililik ilkesi, yasam kalitesi, nafile tedavi ve triyaj basliklarinda yasami destekleyen tedavilerin sinirlandirilmasinin hangi sartlarda mumkun oldugunu etik gerekceler ve ilgili kodlar cercevesinde tartismaktir. Anahtar sozcukler: Etik, tibbi; tedavileri esirgemek; tedavileri sonlandirmak; tibbi yararsizlik; yasam kalitesi.