ABSTRACT
Few physicians write about the ethics of medical practice. Those who do are probably not representative of their colleagues. They are usually committed to a relatively extreme view and either defend the traditional belief in the preservation of life or advocate a position close to that of the euthanasia movement. In order to develop a framework in which to study decisions to treat critically ill patients, it was essential to discuss the issues with physicians who fell at different points along the continuum between these two categories. Critically ill patients were defined as patients (1) who probably would die if not treated during the course of a hospital admission for an acute illness superimposed upon a chronic condition or for aggravation of a chronic condition or (2) who suffered from a debilitating chronic condition which seriously impaired their quality of life. How do the problems of these patients appear in the context of medical practice? Initially, interviews were conducted in a large university hospital. The first physicians were selected from specialties that have frequent contacts with terminal patients, such as oncology and intensive coronary care units. Gradually it became evident that problems concerning the treatment of critically ill patients occur in almost every specialty and with almost every type of patient. Eventually interviews were conducted with pediatricians, internists, oncologists, neurosurgeons, pediatric heart surgeons, pediatric cardiologists and urologists.
