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Milbank Mem Fund Q Health Soc. 1975 Winter;53(1):1-33.

Decisions to treat critically ill patients: a comparison of social versus medical considerations.


A questionnaire survey shows that physicians in four medical specialties evaluate chronically and terminally ill patients not only in terms of the physiological aspects of illness but also in terms of the extent to which they are capable of interacting with others. A patient's potential capacity to perform his social roles depends upon his "salvageability," i;e., the likelihood that he will be able to resume his roles and the degree of irreversible physical or mental damage which indicates his capacity for resuming them. The priorities in terms of treatment are the following: (1) salvageable patients with physical damage; (2) salvageable patients with mental damage and unsalvageable patients with physical damage; (3) unsalvageable patients with mental damage. Within these catagories variables such as patient attitude, family attitude, age, and social class, which define the social environment of the patient, also influence the physician's decision to treat him. Studies of hospital records of cases in two of the specialties were consistent with they survey findings. The findings suggest that there is a disparity between the traditional ethic concerning the treatment of such patients and the actual behavior of many physicians. As a solution to the inconsistencies between ideal and actual behavior, the development of medical guidelines for the withdrawal of treatment with respect ot certain specifically defined conditions is recommended.

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