This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (27)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Social Bookmarking   What's this?

A Moral Algorithm

Edmund D. Pellegrino, MD

JAMA. 2000;283:1065-1067.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The practical ethical question in the case of Reverend G is this: when, if ever, and under which conditions, can his cardiac pacemaker be removed? This is a specific instance of the more generic question of how vigorously physicians are bound to preserve life in patients whose clinical state is seriously deteriorating and if, and under which conditions, life support may ethically be withheld or withdrawn from them. These are the most common ethical questions confronting clinicians at the bedside today. Every clinician is obliged to make these decisions in a morally defensible way. To do so requires some understanding of the moral anatomy of ethical decisions. This article undertakes to expose something of that anatomy as it is revealed in the case of Reverend G.

There are at least 3 levels to any ethical decision: (1) at the most fundamental level are the presuppositions about . . . [Full Text of this Article]

Fundamental Presuppositions

Who Decides?

By What Criteria?

Conflict

Author Affiliation: Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Withdrawing Very Low–Burden Interventions in Chronically Ill Patients
Jill A. Rhymes, Laurence B. McCullough, Robert J. Luchi, Thomas A. Teasdale, and Nancy Wilson
JAMA. 2000;283(8):1061-1063.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Should implantable cardioverter-defibrillators and permanent pacemakers in patients with terminal illness be deactivated?: Patient Autonomy Is Paramount
Zellner et al.
Circ Arrhythm Electrophysiol 2009;2:340-344.
FULL TEXT  

The State of Advance Care Planning: One Decade After SUPPORT
Collins et al.
AM J HOSP PALLIAT CARE 2006;23:378-384.
ABSTRACT  

Medical and Ethical Aspects of Long-term Enteral Tube Feeding
McMahon et al.
Mayo Clin Proc. 2005;80:1461-1476.
ABSTRACT  

End-of-life decision making in dementia: The perspective of family caregivers
Caron et al.
Dementia 2005;4:113-136.
ABSTRACT  

Pacemaker and defibrillator deactivation in competent hospice patients: An ethical consideration
Ballentine
AM J HOSP PALLIAT CARE 2005;22:14-19.
ABSTRACT  

Ethical Issues in Geriatrics: A Guide for Clinicians
Mueller et al.
Mayo Clin Proc. 2004;79:554-562.
ABSTRACT  

Ethical Analysis of Withdrawal of Pacemaker or Implantable Cardioverter-Defibrillator Support at the End of Life
Mueller et al.
Mayo Clin Proc. 2003;78:959-963.
ABSTRACT  

Measuring quality of life: Who should measure quality of life?
Addington-Hall and Kalra
BMJ 2001;322:1417-1420.
FULL TEXT  

Is It Ethical to Withdraw Low-Burden Interventions in Chronically Ill Patients?
Paola et al.
JAMA 2000;284:1380-1382.
FULL TEXT  

Intensive Care Medicine 2000: First Signs of Maturity?
Suter
Anesth. Analg. 2000;90:1236-1237.
FULL TEXT