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Charles L. Sprung, MD, JD

JAMA. 1990;263(16):2211-2215.

Abstract
Advances in medical technology and practices have been associated with improved patient outcomes. At times, the price of this progress has included great financial costs and human suffering. During the last two decades, there have been significant changes in medical practices in America. In the late 1960s and early 1970s, the removal of a respirator or hydration or nutrition from a patient who was not brain dead was considered a deviation from accepted medical practices. In 1976, the Quinlan case allowed the removal of a ventilator from a patient in a persistent vegetative state. Subsequent court decisions in the 1980s have equated hydration and artificial feeding with other forms of life-sustaining treatments and have allowed their withdrawal in patients who were not terminally ill. Prominent physicians have recently stated that it is not immoral for a physician to assist in the rational suicide of a terminally ill patient. Active euthanasia programs in the United States are likely in the near future.

(JAMA. 1990;263:2211-2215)

Author Affiliations
From the Section of Critical Care Medicine, Department of Medicine, Veterans Administration Medical Center and University of Miami School of Medicine, Miami, Fla, and the Department of Anesthesiology, Hadassah University Hospital and The Hebrew University of Jerusalem, Jerusalem, Israel.

Footnotes
Reprint requests to Department of Anesthesiology, Hadassah University Hospital, PO Box 12000, 91120 Jerusalem, Israel (Dr Sprung).

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