Such ethical issues are always difficult. From clinician's point of view: we should save the life, health, and quality of life (take into consideratoion e.g. pain) of patients and try to improve their health status or even stabilize it only. There is common belief: if patient still lives - there is still hope and chance for improvement. From patient's (and their families) point of view such questions are individual and answers my be influenced by another issues: religious, cultural, social, etc. From law point of view: strict restrictions, regulations, and guidelines are required, each takieng into consideration local abilities and conditions. Thus this problem still will be discussed. Maybe technical development and novel technologies in diagnosis, therapy, rehabilitation, and care make another breakthrough in this issue, providing increaased effectivity of the therapy, and increased accuracy of the diagnosis, especially in patients with disorders of consciousness (DoCs). Number of misdaignosed DoCs cases is assessed up to 40 percent now ! - thus accuracy of the diagnosis may be the most important question here.

Such ethical issues are always difficult. From clinician's point of view: we should save the life, health, and quality of life (take into consideratoion e.g. pain) of patients and try to improve their health status or even stabilize it only. There is common belief: if patient still lives - there is still hope and chance for improvement. From patient's (and their families) point of view such questions are individual and answers my be influenced by another issues: religious, cultural, social, etc. From law point of view: strict restrictions, regulations, and guidelines are required, each takieng into consideration local abilities and conditions. Thus this problem still will be discussed. Maybe technical development and novel technologies in diagnosis, therapy, rehabilitation, and care make another breakthrough in this issue, providing increaased effectivity of the therapy, and increased accuracy of the diagnosis, especially in patients with disorders of consciousness (DoCs). Number of misdaignosed DoCs cases is assessed up to 40 percent now ! - thus accuracy of the diagnosis may be the most important question here.

My good friends mother was on life support for several months before she passed away. This friend is teaching at the same university hospital. Being on life support, she was able to witness the marriage of her grandson and participate in the traditional tea drinking ceremony. I also managed to visit her during my holidays, on a thursday, and I commented that she looked fresh and rosy. Her lips were bright pink. But the next day, her daughter told me that mum was pale. I forgot that the ventilator was doing the breathing. She passed away during the weekend, despite the life support. We all wanted her to be on life support, because it's God's prerogative to give life, or to take it away.

Dear Ziad

Orthotanasia is the term used by doctors to define natural death, without interference of science, allowing the patient dignified death without suffering, leaving the development and course of disease. Therefore avoids extraordinary methods of life support, such as drugs and devices, sunk and which have been submitted to support advanced life patients. Therapy persistence in unrecoverable patients may be associated dysthanasia considered death with suffering

This type of approach to the terminal patient will depend on the laws in force in the country where the event is occurring

Thank you Emilia, Miranda, and Nelson for your valuable contributions to this question.

Thanks Bassam!

Dear Ziad: from a bioethical point of view we have to consider a few things. If the patient has planned in advance (for example, a living will), and decided that given the situation and when there's no chance of recovery he doesn't want to be in life support, we have to respect his decision, if he was autonomous and competent. Then, you have the situation when you have to arrive to a consent with family/proxies. in that case you have to analize if the burden place on the patient with life support is so great that overrides it's benefits, if its disproportionate with the therapeutic goal (for example, you just thinking about comfort treatment because there's no chance of cure), and you also consider proximity of death (terminal stage, agony stage, etc.). The main thing to keep in mind is that withdrawing or witholding life support is a medical decision that patient/family could either accept or not. Life support, as The Hastings Center states, is a treatment that just postpone death, but can't avoid it. When you decide to whithold or withdraw life support you`re only thinking about letting the patient go, letting illness just go on it's natural course. You're not killing the patient, because that's not doctor's intention and patient is dying because of his illness not because of medical action. We have to remember that virtuous medical action is taking a just middle point between therapeutic obstination and abandonment of a patient. Law just goes along medical decision but is not it's duty to impose a medical treatment, or to say which is the right medical treatment, that's "lex artis" bussiness (scientific medical knowledge).

Susie.

Thanks Susie!

I would like to share a little story with you. I had a friend who was terminally very ill (cancer) and he was hospitalized for quite a while and one day I visited his immediate doctor for a medical opinion, he simply said to me "his case is leading no where, he will not make it, we are wasting many valuable medical attention and expensive medications on your friend, I advise that he should move back to home to die in peace!" I was chocked by such a cruel argument (in his opinion, it was a scientific opinion and judgement). When I informed his wife she got scared and immediately we moved him to another hospital. Within three weeks my friend completely overturned his case and was energetic for one wee, and then he collapsed and in another week passed away.

So, as many of my colleagues here have defined the issue. Should we simply pull the plug? I guess it is extremely difficult thing to do, religiously we have no option to do it, medically, it is the duty of the doctor to do his/her job and leave the rest to God Almighty.

The debate is ongoing although using the term "Mercy Killing". Many governments say it is illegal. But, also defining the medical case "as referred to Brain Dead?" is another argument that recently some religious authorities are trying to come out with a decision.

Thanks Hussin for sharing this touching story on the subject matter with us!

Maybe the worst feeling is felt when you see some body you love so much in agony, and you cannot do anything to help.

Indeed Hussin!