The Ethics of Withdrawing Artificial Food and Fluid from Terminally Ill Patients: an end-of-life dilemma for Japanese nurses and families

End-of-life issues have become an urgent problem in Japan, where people are among the longest lived in the world and most of them die while connected to high-technology medical equipment. This study examines a sensitive end-of-life ethical issue that concerns patients, families and nurses: the withdrawal of artificial food and fluid from terminally ill patients. A sample of 160 Japanese nurses, who completed a questionnaire that included forced-choice and open-ended questions, supported this act under only two specific conditions: if the patient requested it, and if it relieved the patient’s suffering. They considered that the doctor’s orders, the family’s request, or the patient’s advanced age did not ethically justify this act. A small number of people who had recently lost a relative took part in semistructured interviews focusing on their experiences of their terminally ill relatives being given artificial food and fluid. Ethical, social and cultural factors surrounding this issue are discussed.

Assessment of Social Value in the Allocation of CT Scanners – A Case Study

SummaryThis paper describes a case study on the application of decision analytic procedures to the allocation of computer tomography in a given metropolitan health service area, the Munich Metropolitan Area. The analysis could be used as a decision-aiding and decision-supporting instrument for government regulators in making rational resource allocation decisions as to locating high-cost, high-technology medical equipment. Explicit value judgments, reflecting the monetary equivalent of the different categories of benefit, are introduced to facilitate the comparison between decision options. The difference between the (incremental) benefits, measured in monetary terms, and the (incremental) costs is called the net social value and used as the overall decision criterion.Any alternative with positive net social value is judged economically justifiable, and the alternative with the greatest net social value - subject to its stability as to various sensitivity tests on input parameters - is judged to be most attractive from a societal viewpoint.