Goldberg I V, Sprotzer I
Rider College, Lawrenceville, NJ.
Health Care Superv. 1990 Dec;9(2):33-42.
Many of the issues surrounding refusal and withdrawal of medical treatment are so new and complex that the U.S. society has not resolved the ethical or legal questions involved. Questions such as where life ends and death begins, how to determine the circumstances when withdrawal of treatment is appropriate, and who should make such decisions will have to be resolved before the law in this area can become settled. Naturally, society is a long way from resolving these issues, since they involve such fundamental social, moral, medical, and legal considerations. Nevertheless, a body of law has developed that increasingly recognizes the right of an individual to direct his or her own medical care. To that end, an individual's clearly expressed intention to discontinue medical treatment will generally be honored, even if death results from the withdrawal of that treatment. Legislatures and courts have also encouraged health care providers to abide by the wishes of their patients by giving immunity to health care providers who comply in good faith with the provisions of a living will. Courts have also been reluctant to impose liability on health care providers for withdrawal of treatment absent a living will if it were done in good faith (with the consent of family or guardian) and was in accordance with accepted medical practice. It would appear that as the law gives individuals increased control over the private matter of their own medical treatment, health care providers may face more civil suits for maintaining life support systems against the patient's (or family's) wishes. In any event, while society is in the process of catching up with medical technology, individuals can best protect their right to medical self-determination by expressing their wishes clearly in the form of a living will and durable power of attorney. Health care providers can best protect themselves by keeping abreast of medical and legal developments in connection with these issues and by communicating effectively with their patients as to their wishes regarding life-prolonging medical treatment.
许多围绕拒绝和停止医疗治疗的问题是如此新颖和复杂，以至于美国社会尚未解决其中涉及的伦理或法律问题。诸如生命何时结束、死亡何时开始，如何确定停止治疗合适的情形，以及应由谁做出此类决定等问题，必须在该领域的法律得以确定之前得到解决。自然地，社会距离解决这些问题还有很长的路要走，因为它们涉及如此基本的社会、道德、医学和法律考量。尽管如此，已经形成了一套法律体系，越来越认可个人指导自身医疗护理的权利。为此，个人明确表达的停止医疗治疗的意愿通常会得到尊重，即使停止治疗导致死亡。立法机构和法院也鼓励医疗服务提供者遵守患者的意愿，给予善意遵守生前遗嘱条款的医疗服务提供者豁免权。如果在没有生前遗嘱的情况下善意地（经家属或监护人同意）且按照公认的医疗惯例停止治疗，法院也不愿让医疗服务提供者承担责任。随着法律赋予个人对其自身医疗治疗这一私人事务更多控制权，医疗服务提供者可能会面临更多因违背患者（或家属）意愿维持生命支持系统而引发的民事诉讼。无论如何，在社会追赶医疗技术发展的过程中，个人可以通过以生前遗嘱和持久授权书的形式清晰表达自己的意愿，来最好地保护自己的医疗自主决定权。医疗服务提供者可以通过紧跟与这些问题相关的医学和法律发展，并就患者关于延长生命的医疗治疗的意愿与患者进行有效沟通，来最好地保护自己。
