[ back to Appleton Consensus on the timeline ]

Quotations from "The Appleton Consensus: Suggested International Guidelines for Decisions to Forgo Medical Treatment"

(For full document, see Lawrence University site for The Appleton Consensus)

From Part I -- Requests for treatment:

"Doctors also have a strong prima facie obligation to respect patients' requests for life-prolonging treatment. However, certain qualifications are relevant:  (a) Doctors are not obliged to provide physiologically futile treatments (ie treatments that cannot produce the desired physiological change). Where a doctor considers a life-prolonging treatment not to be physiologically futile, but nonetheless 'futile' in another sense of the word because of the low probability of success or because of the low quality of life that would remain, then decisions about the withholding or withdrawal of such treatments should be made in the context of full and open discussion of the nature and extent of the 'futility' of the treatment with the patient or the patient's representative; . . . (c) If a doctor has a conscientious objection to a requested treatment that doctor is not obliged to provide it. The doctor should explain all treatment options and his or her position regarding them. If the patient wishes, the doctor should arrange an orderly transition to another doctor of the patient's choice; (d) Scarcity of resources may sometimes require overriding a patient's request for a life-prolonging treatment (see Part IV)

From Part II --  "Decisions involving patients who have lost the capacity to make decisions:"

"Intervention with the primary intention of causing death (as distinguished from forgoing treatment that is deemed inappropriate) has no place in the treatment of permanently incapacitated patients. However, vigorous treatment to relieve pain and suffering may well be justified, even if these interventions lead to an earlier death."

From Part IV -- withdrawing treatment "under conditions of scarcity," on the role of

  • Justice in the decision-making:  "Respect for the total benefit of society would require that whenever medical procedures that could be beneficial to individuals have to be limited because of scarcity, available resources should be allocated among persons so that they produce the greatest overall utility. Such allocation inevitably conflicts with respect for the ethical dimensions of both need and property."
  • Efficiency:  "The maxim of efficiency follows from the principles of non-maleficence and beneficence. It requires that a given expected outcome of any medical procedure, including a life-prolonging procedure . . ought to be achieved at the least opportunity-cost. The force of the principle derives from the fact that, should the principle not be met, fewer resources would be available, either immediately or at some future date, for accomplishing other desired and ethical outcomes.  . . . [W]hen resources available to the doctor are limited, efficiency requires that resources ought not to be employed if the benefits to a particular patient are judged to be less than the benefits denied to others for whom the same doctor has responsibility."