A preliminary list to identify attitudes toward different conditions for discussing possible termination or refusal of medical treatment except for pain relief.

Effective communication about decisions concerning termination or refusal of medical treatment except for pain relief necessitates clarifying the attitudes of those in the decision-making process. Effective communication increases the likelihood that a patient's advance directives are implemented and decreases the likelihood of litigation. Psychotherapists, counselors, chaplains, etc. can be facilitators of effective communication. This study generated a list for use in discussion by asking persons who cared for individuals with terminal illnesses, critical injuries or elderly people what conditions seemed appropriate for termination or refusal of medical treatment except for pain relief. The 182 out of 204 individuals who contributed conditions showed clear agreement on terminal illnesses, brain disorders, dependence on machines for life, and other irreversible deterioration or severe loss of quality of life, lack of suitable treatment, patient's wish, and concern about the effect of the patient's condition on others. Some specified further qualifications, such as at what point during a terminal illness termination or refusal was appropriate. The list with notes could be appended to a Living Will or a Durable Power of Attorney for Health Care. The notes should be updated periodically. Through use and research, the list also can be refined further.