ABSTRACTThis paper examines how decisions to limit treatment to critically ill patients under uncertainty can be made rationally. Expected utility theory offers one way of making rational decisions under uncertainty. One problem with using this approach is that we may not know the value of each option. One rational course open is to treat until further information becomes available. However, treatment can limit the range of options open. With treatment, a patient may recover such that he no longer requires life‐supporting (...) treatment. However, his life may be not worth living. If active euthanasia of %on‐terminal’conditions is prohibited, the option of dying will no longer be available. Taking a rational‘wait and see’course may result in being trapped within an unbearable life. On the other hand, sometimes present practice‘lets nature takes its course'. Critically ill patients are allowed to die because it is believed that their lives will be not worth living. It is likely that some patients are allowed to die when there is some objective chance of worthwhile future life. This paper argues that a policy of treating critically ill patients until the nature of future options can be better evaluated, in company with an offer of subsequent euthanasia where appropriate, allows a more rational and humane approach to treatment limitation decisions under uncertainty. (shrink)

As the single most important experience in the lives of all people, the process and event of death must be handled carefully by the medical community. Twentieth-century advances in life-sustaining technology impose new areas of concern on those who are responsible for dying persons. Physicians and surrogates alike must be ready and willing to decide not to intervene in the dying process, indeed to hasten it, when they see the autonomy and dignity of patients threatened. In addition, the very ways (...) we talk about death and dying need to come under scrutiny, and it is likely that our technical advances should be parallelled by equally arduous advances in the semantic and rhetorical approaches we take to death. (shrink)