earlier expressed wishes or those of family members.
Interestingly enough, an editorial in the Journal of the American Geriatrics Society noted that there is even an issue in the discussion that involves semantics. Brody (1995) noted that for at least the past two decades physicians have objected to making decisions about ceasing life-sustaining medical treatment based on the distinction between withdrawing and withholding therapy. According to Brody (1995), this distinction is a pernicious one that confuses the debate. He contended that physicians did not want to have that terminology used in making medical decisions or thinking about the ethical issues involved. His suggestion was that the focus simply be on stopping life-sustaining medical therapy, without making the distinction between withdrawing it (which presupposes something already given) or withholding it (which presupposes that someone is being deprived of life-saving or sustaining activity). It is clear that in the debate about end-of-life issues, there is a great deal of confusion, concern, and worry about the ramifications of those decisions ethically and legally.
The legal system, through both the courts and the legislature, have tried to clarify the issues. For example, The Patient Self-Determination Act was designed to address two issues: the need to preserve patient end-of-life autonomy and choice-making, and the need to reduce the costs of unwanted medical treatment to the remaining family members and to society as a whole. It requires health care facilities receiving Medicare and Medicaid funding to undertake a range of services, and support the options of individuals seeking to have services withheld or withdrawn (Galambos, 1998). This did not solve all the problems, however, some of which will be addressed in the following pages.
The ethical issues regarding withholding or withdrawing treatment are ever more complex. Clearly human beings can...