Introduction

By introducing major modifications in the historical concepts underlying medical treatments, science and technology have created a certain “chaos” in the care of seriously ill patients. What might have been considered good medical practice for advanced disease before the “biological revolution” is now questioned. Where to draw the line? Where to set limits? Many variables now must be considered in the management of patients with advanced illnesses, including the recognition of ethics as a foundation for clinical practice, the acknowledgment of new rights, and social changes related to health care. Ethical and legal considerations now must constantly inform decision making. Medicine has been caught in a difficult dilemma: Not only does it have to consider its own complexities, but it also has to face a much different social context than existed just a short time ago.

Numerous ethical guidelines and recommendations have been proposed by diverse authorities to help clinicians in their decision making. Recommendations can be found in reports of special presidential or national commissions (2,3), in major congressional reports (4), in policy statements of national organizations (5,6), in guidelines from bioethics institute (7), and in professional journals (8). There is now a body of literature, policy, and law that present an agreed upon set of principles and values, as well as recommendations, for clinical practice.

Nevertheless, medicine's appropriation of these guidelines is lagging behind, as demonstrated by numerous studies on medical practices.