Trying to draw distinctions in the ethical issues surrounding care of terminally ill patients often results in more questions than answers, says an expert in bioethics and philosophy.

Gladys B. White, policy analyst and study director for the Office of Technology Assessment, discussed the findings of several studies done by his office for members of the U.S. Congress last week at the third annual Utah Cancer Symposium at Brigham Young University.The Office of Technology Assessment's basic function is to help legislators anticipate and plan for the positive and negative impacts of technological changes.

Dramatic advances in medical technologies have raised a number of ethical questions, particularly regarding the use of life-sustaining technologies.

A report on life-sustaining technologies and their use with elderly patients focused on five techniques: cardiopulmonary resuscitation (CPR); mechanical ventilation; renal dialysis; tube and intravenous feeding and hydration; and antibiotic therapy for life-threatening infections.

More than half of all patients who receive CPR and tube feeding, and approximately one-third of patients who receive mechanical ventilation, dialysis and intravenous feeding procedures are over age 65, according to the report.

"The most controversial area is whether intravenous nutrition and hydration is a medical technology or an aspect of essential care," White said.

Medical personnel, in trying to deal with the appropriate use of these life-sustaining technologies, often try to draw distinctions, White said. These distinctions include withdrawing vs. withholding treatment and direct vs. indirect effects of their actions.

White gave an example of an elderly man who was suffering from several major medical problems, including terminal cancer, and who had been given a "no code" order (no attempts would be made to resuscitate him). The man was being maintained with tube feedings, antibiotic treatment and mechanical ventilation.

When his intravenous line slipped out of place, some of the medical staff felt they were not obligated to restart the treatment, while others did.

"In initiating life-sustaining treatment (the medical staff) makes a promise that requires that treatment not be stopped," White said. It is important for medical staff to adhere to values of truth telling, loyalty and compassion in such situations, White said.