Life-sustaining therapy and dignified death. Myths and realities.

The use of a variety of diagnostic and therapeutic procedures made available by modern technology for critical patients have given rise to forms of death which are incompatible with a person's dignity in cases in which the inevitable occurrence of death is inexplicably delayed. The search for the multiple factors influencing this phenomenon, related to the development and progress of medicine, leads to the investigation of four aspects deemed essential in their determination: imperative technology, sanctity of life, omnipotence of medicine and the lack of a unique medical decision. Apart from the availability of high technology, there is an increasing requirement of the patient's full autonomy with respect to the decisions involving the end of his life, which include the debated right to die. In the struggle towards death with dignity in a context where practical decisions are required, the following are taken into account: refusal of treatment, irreversibility of clinical diagnosis and palliative support, and withholding and withdrawal of life-sustaining therapy.