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Abstract

Now medical care has been transformed. We recognize that the human organism is a complex interaction of many different systems-respiratory, circulatory, neurological, digestive, and so on. Some of them can fail and create both problems and opportunities we did not formerly have. One of the opportunities we now have is that we can keep people alive who in an earlier era would not have survived. And one of the problems we now have is also that we can keep people alive who in an earlier era would not have survived. Some of them are kept alive with such diminished capacity that we are not sure that on the balance it is what we ought to do. Indeed, often we have the capacity to keep people alive who are sure themselves that it does them no benefit. That one possibility transforms the relationship between physicians and patients. Instead of patients hoping that medical intervention can do for them some part of what they want, patients now confront the question, "How much of what doctors can do do I want done?" That is a new kind of question, and it has changed the distribution of decisional authority. Some cases of physicians wanting to do more than the patients want done have even lead to litigation.

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1996 Baker-Hostetler Lecture

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