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The Role of Courts

Until recently, decisions about the withdrawal or withholding of death-delaying treatment were debated by ethicists and civil libertarians but were not a fundamental problem for practicing physicians. Decisions were made, the courts were seldom involved, and there were few malpractice lawsuits or criminal prosecutions. While it is tempting to assume that this benign neglect of the law can continue without risk, it is a badly premised assumption. The historical societal premise in critical care medicine was that health care providers would do everything possible for the patient.

With the advent of diagnosis-related groups (DRGs) and other forms of prospective payment, the general public is beginning to be concerned that health care providers are doing less for patients for whom it is financially rewarding to do less. This erosion of public confidence, combined with the real pressure on physicians to do less for DRG patients, makes it imperative that decisions that will lead to premature death be carried out in a legally impeccable manner. Ultimately, adhering to legal principle is the best defense against administrative pressures to compromise patient care for the sake of optimal reimbursement.

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