The past 30 years have seen dramatic advances in the capabilities of mechanical ventilators and in those of the medical personnel who use them. Mechanical ventilators have become one of the three major artificial life-support systems of the 1980s. The greatly widened use of ventilators has been accompanied by changing ethical implications鈥� dilemmas are regularly posed that virtually never occurred 30 years ago. Some of these dilemmas are identified and a few broad principles are set forth that may prove helpful in making the hard decisions regularly required of physicians who are concerned with administering mechanical ventilation to seriously compromised patients.
MECHANICAL VENTILATION AT MIDCENTURY听
The tank respirator, or iron lung, the best respirator of 30 years ago, was relatively inexpensive, simple in principle, and easy to maintain. It was effective in ventilating patients with neuromuscular disease, especially once they entered a "subacute" or "chronic" phase of their disease. Patients