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Physicians' Interests

From early Greece, physicians have been committed to curative treatment whenever possible. Physicians have always used whatever technology was available, sometimes without regard to its effects on patients. The Hippocratic Oath's proscription of cutting for stone was based on the operation's uniform failure rate, not an aversion to technology. Physicians embraced life-support technologies as they became available. While originally intended to support metabolism while the patient recovered from a specific pathology, patient demands and insurance incentives soon made life support an end as well as a means.

While physicians have financial interests in life-support decisions, they are not as great as those of hospitals. The physicians' stakes are much more emotional than financial. Physicians are torn between the urge to help specific identified patients avoid unnecessary suffering and a traditional reluctance to talk to patients about death and dying. Irrespective of their personal feelings, they are under pressure from hospitals, managed care providers, and the federal government to save money by denying and terminating life support. This pressure is directed at all patients, not just those who are clearly terminally ill.


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