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Caring for dying patients is not about prolonging life at all costs

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3027 (Published 28 May 2013) Cite this as: BMJ 2013;346:f3027
  1. Michael Ashby, professor and director of palliative care, Royal Hobart Hospital, Southern Tasmania Area Health Service, and Faculty of Health Science, University of Tasmania
  1. michael.ashby{at}dhhs.tas.gov.au

All societies need to limit medical treatment for patients reaching the end of life, as per the Liverpool care pathway, says Michael Ashby, describing a Tasmanian initiative

If the sole goal and ethicolegal imperative of medicine is to prolong life, then the Liverpool care pathway could be seen as “euthanasia lite,” as Eugene Breen wrote recently in a letter to the BMJ.1 However, the underlying tenet of his letter seems to misunderstand the scope and goals of medicine.2 3 The mode of dying in 2013, for those who do not die suddenly, tends to be one of gradual decline over months or years, with accumulating chronic disease and symptoms. This results in decreased independence and more encounters with the healthcare system.4 This is a global, bioethical, ecological, and economic challenge, especially in countries of the OECD, where we risk spending increasing proportions of GDP on buying people an expensive dying process that fails to meet needs or wishes.

Medicine needs to respond to the care of dying people in their last months and years of life, not just for a few short hours before death. A monist, technological imperative that says “save life at all costs” is outdated and dangerous in an epoch when to extend life we have means that never existed before. With the current concern in …

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