Donation After Circulatory Death: When Withdrawing Life-Sustaining Treatments Is Ethically Acceptable

The possibility to determine death based on cardiocirculatory criteria in controlled cases, namely when there is a request to withhold treatment—or, more frequently, withdraw it—specifically recalls the recent Italian law on advance treatment directives and leaves the following question unanswered: Under what conditions is the patient's request legally and ethically acceptable? We present three ethical proportionality criteria for supporting physicians’ decision-making facing patients’ requests of treatment withdrawal, namely: 1. irreversible pathology with an ominous and worsening prognosis; 2. within an evaluation considering both clinical data and the patient's history; and 3. facing burdens that are no longer bearable. We finally argue that reflection over controlled donor may be a model for giving medicine the chance to responsibly deal with broader end-of-life issues.