Decision Making Process on Death and Dying

. . was the exclusive province of the longanimous, the patient's family and the treating physician." Today, just about 80 percent of patients, in 1994 in America 5,500 volume a day, die in hospitals and other institutions. In 1950, 600,000 people in the United States were bestride 85 or one-time(a); by the year 2030, an estimated eight million Americans will fall into place that age. In 1989, 12 percent of that population was over age 65; by 2030 an estimated 20 percent. About 70 percent of those who die in institutions "die as a endpoint of roundone's decision to withdraw or withhold life-sustaining treatment."

Americans are living longer, in large part because of advances in medicine. Kadish says that "today, inveterate regenerative unsoundnesss such as cancer, heart disease and cerebrovascular disease call for become predominant, accounting for approximately seventy percent of all deaths in the United States." These same medical advances, including electric organ transplants, organ repairs, organ substitution (respirators, ventilators and renal dialysis machines), drugs and breakthroughs in contractable and biotechnology, transferer the promise of significantly extended life spans. Urofsky account in 1994 that "the rate of discovery was not slowing d stimulate, and the fractional life of new techniques and medicines might be no much than five or six years.

People who would have died from injuries or diseases or just the ravages of age can now be kept alive." He says that "the

In a number of areas, when the dying patient's wishes are unclear and disputes arise, courts have differed in their approach as to how, by whom and what basis medical treatment decisions should be made. Tarantino says that many courts "assume a patient wants life support unless the family can prove otherwise at the highest level of proof.

" The result is that "thousands of incompetent unconscious patients [are] sustained, perhaps against their own will, causing needless family anxiety, clogging of the courts, uncomfortable legal delays, and the withering of finite health dollars." An example is the case of Rocco Musolino in mendelevium in 1990. His wife asked Dr. Katz to put a 'Do Not Resuscitate' locate on his medical sheet pursuant to a provide in Rocco's will which gave her power of attorney. Katz refused. A hospital ethical motive committee recommended that Rocco be examined by a psychiatrist. He was at last determined to be non-compos mentis. Then Dr. Katz asked the hospital to reopen the case. A second doctor finally agreed to cut off his dialysis and Rocco died two months after the dispute erupted. Urofsky's comment is that in some situations, "instead of death coming peacefully and with dignity, there is involution and suffering, rage and public controversy."

Lynda M. Tarantino, Withdrawal of Life Support: competitiveness Among Patient Wishes, Family, Physicians, Courts, Statutes and the Law, 42 Buffalo L. Rev. 624-652 (Spring, 1994).

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