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J Pain Symptom Manage. 2009 Sep;38(3):473-6. doi: 10.1016/j.jpainsymman.2009.06.003.

The defined trial period in ethical decision making.

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Palliative Care Consultation Service, St Joseph Health System, Santa Rosa, CA 95405, USA.


In the face of acute life-threatening illness, especially when superimposed upon chronic illness, patients and their families often face great difficulty in establishing treatment preferences and goals of care. This is especially true early in treatment when prognostication is difficult. The "defined trial period" is discussed and emphasized as a useful strategy in resolving some of these dilemmas. This strategy depends on acceptance of the moral and legal equivalency of withholding and withdrawing treatment. An unusual case is presented in which the use of a defined trial period enabled the entire care team to form a consensus on a treatment plan. Society faces a great challenge in how it balances competing interests in the allocation of scarce resources.

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