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Physicians and Futile Care: Using Ethics Committees to Slow the Momentum

Published online by Cambridge University Press:  29 April 2021

Troyen A. Brennan
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Extract

The subject of physician efforts to limit care by unilaterally withholding particular therapies, even if the patient, or the family of an incompetent patient, wishes continued care, plays an increasingly prominent role in discussions of clinical medical ethics. Some providers have described a professional duty to define the futility of care, and to act on the determination of futility even in the face of the patient’s, or a surrogate’s, resistance. This aggressive stance has gained intellectual momentum and may be percolating down into clinical practice.

Given the history of the medical profession's diffident attitude toward patients’ rights and its reliance on well-meaning paternalism, the notion that doctors should determine futility and limit access to specific interventions must be carefully scrutinized. Indeed, the emergence of two other themes in health policy and ethics, in particular the living will/power of attorney initiative on the one hand and the open discussion of rationing care in Oregon on the other, tends to undermine the key rationales for physician control over futile care.

Type
Article
Information
Law, Medicine and Healthcare , Volume 20 , Issue 4 , Winter 1992 , pp. 336 - 339
Copyright
Copyright © American Society of Law, Medicine and Ethics 1992

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References

Brennan, T.A., “Do Not Resuscitate Orders for the Incompetent Patient in the Absence of Family Consent,” Law, Medicine & Health Care. 1986;14:13–19.Google Scholar
Blackhall, L.J., “Must We Always Use CPR?” N Engl J Med 1987;317:1281–1285.CrossRefGoogle Scholar
Brennan, T.A., “Incompetent Patients with Limited Care in the Absence of Family Consent: A Study of Socioeconomic and Clinical Variables,” Annals of Internal Medicine. 1988;109:819–825.Google Scholar
Murphy, D.J., “Do Not Resuscitate Orders: Time for Reappraisal in Long Term Care Institutions,” JAMA. 1988;260:1098–2101; Faber-Langendoen, K., “Resuscitation of Patients with Metastatic Cancer: Is Transient Benefit Still Futile?” Archives of Internal Medicine. 1991;151:235–239.Google Scholar
Schiedermayer, D.L., “The Decision to Forego CPR in the Elderly Patient,” JAMA. 1988;260:2096–2097.CrossRefGoogle Scholar
Miles, S.H., “Informed Demand for Non-Beneficial Medical Treatment,” New Engl J Med. 1991;325:512–515.CrossRefGoogle Scholar
Katz, J., The Silent World of Doctor and Patient. New York: Free Press, 1984.Google Scholar
Bedell, S.E., Delbanco, T.L., “Choices About Cardiopulmonary Resuscitation in the Hospital: When Do Physicians Talk with Patients?” New Engl J Med. 1984;310:1089–1093.CrossRefGoogle Scholar
Reinhardt, U.E., “Breaking American Health Policy Gridlock,” Health Affairs. 1991;10:96–103.CrossRefGoogle Scholar
Lubitx, J., Prihoda, R., “Use and Cost of Medicare Services in the Last Two Years of Life,” Health Care Financing Review. 1984;5:117–131.Google Scholar
Paris, J.J., Crone, R.K., Reardon, F., “Physicians Refusal or Request of Treatment: The Case of Baby L,” New Engl J Med. 1990;322:1012–1015.CrossRefGoogle Scholar
Fourth Judicial District (Dist. Ct., Probate Ct. Div.) PX-91-283, Minnesota, Hennepin County.Google Scholar
Miles, S.H., “Informed Demand for ‘Non Beneficial’ Medical Treatment,” New Engl J Med. 1991;325:511–512.Google Scholar
Angell, M., “The Case of Helga Wanglie.” New Engl J Med. 1991;325:511–512.CrossRefGoogle Scholar
Brennan, T.A., Just Doctoring: Medical Ethics in the Liberal State, Berkeley, CA: University of California Press, 1991.CrossRefGoogle Scholar
Emanuel, L.L., Berry, M.J., Stoeckle, J.D. et al., “Advanced Directives for Medical Care—A Case for Greater Use,” New Engl J Med. 1991;324:889–895.CrossRefGoogle Scholar
Annas, G.J., “The Health Care Proxy and the Living Will,” New Engl J Med. 1991;324:1210–1213.Google Scholar
White, M.L., Fletcher, J.C., “The Patient Self-Determination Act: On Balance More Help Than Hindrance,” JAMA. 1991;266:410–412.Google Scholar
Joint Commission on Accreditation of Health Care Organizations, Accreditation Manual for Hospitals. Oakbrook Terrace, IL, 1991.Google Scholar
Brunetti, L.L., Carperas, S.D., Westlund, R.E., “Physicians Attitudes Towards Living Wills and Cardiopulmonary Resuscitation,” Journal of General Internal Medicine. 1991;6:323–329.CrossRefGoogle Scholar
Callahan, D., Setting Limits. New York: Simon and Schuster, 1987.Google Scholar
Blumstein, J.F., “Age Based Rationing of Medical Care: A Legal and Policy Critique,” St. Louis University Law Journal. 1989;33:693–705.Google Scholar
Daniels, N., “Is the Oregon Rationing Plan Fair?” JAMA. 1991;265:2232–2235. Vladeck, B.C., “Unhealthy Rations,” American Prospect. 1991; Summer: 100–105. Budetti, P., “Rationing in Oregon: A Lion in Sheep's Clothing,” Health Matrix. 1991;1:312–339.CrossRefGoogle Scholar
Brennan, T.A., Just Doctoring: Medical Ehtics in the Liberal State. Berkeley, CA: University of California Press, 1991.CrossRefGoogle Scholar
Youngner, S., “Who Defines Futility?” JAMA. 1988;260:2094–2095.CrossRefGoogle Scholar
Emanuel, L.L., Berry, M.J., Stoeckle, J.D. et al., “Advanced Directives for Medical Care—A Case for Greater Use,” New Engl J Med. 1991;324:889–895.CrossRefGoogle Scholar
Brennan, T.A., “Ethics Committees and Decisions to Limit Care: The Experience of the Massachusetts General Hospital,” JAMA, 1988.CrossRefGoogle Scholar
Emanuel, E., The Ends of Human Life. Cambridge, MA: Harvard University Press, 1991.Google Scholar
Robertson, J.A., “Ethics Committees in Hospitals: Alternative Structures and Responsibilities,” Issues in Law and Medicine. 1991;7:83–93.Google Scholar
Emanuel, L.L., Berry, M.J., Stoeckle, J.D. et al., “Advanced Directives for Medical Care—A Case for Greater Use,” New Engl J Med. 1991;324:889–895.Google Scholar
Goetzler, R.M., Moskowitz, M.A., “Changes in Physician Attitudes Towards Limiting Care of Critically Ill Patients,” Archives of Internal Medicine. 1991;151:1537–1540.CrossRefGoogle Scholar
Lo, B., “Behind Closed Doors: Promises and Pitfalls of Ethics Committees,” New Engl J Med. 1991;317:46–49.Google Scholar
Hafemeister, T.L., Keilitz, I., Banks, S.M., “The Judicial Role in Life-Sustaining Medical Treatment Decisions,” Issues in Law and Medicine. 1991;7:53–73.Google Scholar