New guidelines on foregoing life-sustaining treatment in incompetent patients: an anti-cruelty policy.

When certain ailments are an overwhelming and irremediable encumbrance, treatment directed at other curable ailments, although life-saving, cannot effectively achieve the goals of medicine. We are morally constrained from perpetuating the effects of a hopeless injury without prospect of benefit to the patient. An anti-cruelty policy is proposed as a new guideline for foregoing life-sustaining treatment that transcends the doctrines of "substituted judgment" or "reasonable persons" for certain incompetent patients. We propose the use of "anti-cruelty care" as an active chart order or progress note, and suggest that institutional ethics committees or governing bodies recommend its implementation.