Report for Difficulties Tridjoko Hadianto

PROBLEMS It has become commonplace for technological growth to outstrip society's methods of dealing with it. Nowhere is this more true than in medical care. Life-saving equipment and techniques at times work only to preserve a semblance of life. These tragic results are becoming increasingly common. Physicians, when unable to predict what treatment will achieve in an individual case, must apply the best treatment available in emergency situations. But after a patient is stabilized, the prognosis often becomes clear, and the patient's family and physician may have to confront difficult questions: Is it ethical to discontinue treatment? Is it ethical to continue? Having to make hard decisions is becoming more frequent, producing in recent years a number of highly publicized, emotionally charged court actions over the ethical approach to withdrawal of treatment.

MEDICAL ETHICS COMMITTEES ROLE Medical ethics committees have been established in recent years. They are useful for consultation regarding complicated cases. Legal, medical, and ethical ramifications of a decision can be explored. Different views regarding prognosis and indications for treatment can be exposed. Arguments about "quality of life" can be closely scrutinized. In particular, conflicts among family members or among the medical and nursing team can be mediated. Committee review may provide assurance that full and impartial consideration has been given to a difficult ethical decision. Committees should be used for consultation and review; they should not be substituted for the responsible decision of the attending physician.

Six potential functions of ethics committees PRINCIPLES Six potential functions of ethics committees 1. Review a case to confirm the physician's diagnosis or prognosis of a patient's condition. 2. Review decisions made by physicians or surrogates about specific treatment. 3. Make decisions about suitable treatment for incompetent patients. 4. Provide general educational programs for staff on how to identify and solve ethical issues. 5. Formulate policies to be followed by staff in certain difficult cases. 6. Serve as consultant for physicians, patients, or their families in making specific ethical decisions.

CONCLUSION Decisions concerning the care of people who are near death, whether they are old or newborn, involve many medical and ethical difficulties. There is no way to ensure that such decisions will be easy, but we can ensure that insofar as humanly possible such decisions will be well-informed and responsible and made with the benefit of the patient as the foremost and determining factor.

REFERENCES Bernard , L.O. 1995. Resolving Ethical Dilemmas; A Guide for Clinicians, Williams & Wilkins, Baltimore-Maryland, USA. DeBlois, J., Norris, P & O’Rourke, K. 1994. A Primer for Health Care Ethics, Georgetown University Press, Washington DC. Jonsen, A.R., Siegler,M & Winslade, W.J. 1982. Clinical Ethics, Bailliere Tindall, London. Monagle, J.F. & Thomasma, D.C. 1998. Health Care Ethics; Critical Issues for the 21st Century, An Aspen Publication, Gaithersburg-Maryland, USA.