Physician Refusal of Requests for Futile or Ineffective Interventions

Abstract

Several recent articles raise an issue long unaddressed in the medical literature: physician compliance with patient or family requests for futile or ineffectice therapy. Although they agree philosophically that such treatment ought not be given, most physicians have followed the course described by Stanley Fiel, in which a young patient dying of cystic fibrosis was accepted “for evaluation” by a transplant center even though he has already passed the threshold of viability as a candidate for a heart-lung transplant. Dr. Fiel reported this action was taken not in the hope of doing the transplant but so that the family could assure themselves they had done “everything possible.” The patient, after a long and stressful cross-country flight, arrived at the hospital in respiratory failure. He died soon thereafter far from home and familiar surroundings.

Care at the Edge of Viability: Medical and Ethical Issues

“…38,39 When treatment is deemed futile 37 and society judges the cost to be unacceptably high relative to benefit, 39 then it is mandatory not to provide treatment. In fact, as argued by Paris and Reardon, 40 it should be considered ethical and moral to not offer options for futile treatment because this undermines patient autonomy, misinforming patients that options exist when they do not. When outcomes are "uncertain" or "ambiguous," 37,38 however, society might reasonably, although not universally, consider the cost to be acceptable in relation to the value.…”

Marginale Wirksamkeit als Posteriorisierungskriterium – Begriffsklärungen und ethisch relevante Vorüberlegungen

“…Die Argumente, die für und wider den Ausschluss sinnloser Leistungen verhandelt wurden, kreisten um Begriffe wie Patientenwohl und Patientendienlichkeit, ärztliche Integrität, Autonomie und Paternalismus sowie die Ziele der Medizin [4,15,20,22,27,28,31,36,37,40,41]. Ob sinnlose Maßnahmen den Geboten guter Medizin widersprechen oder nicht, sollte ausdrücklich unabhängig von Allokationsfragen erwogen und nicht mit bestehenden Rationierungsinteressen vermischt werden.…”

Successful Islet Transplantation for Patients with Diabetes — Fact or Fantasy?

“…29 Others have argued in favor of physicians' autonomy -that is, that there are limits to physicians' obligations to provide care that they believe has no benefit. [30][31][32][33][34][35][36][37][38] Paris and Reardon stated this view most clearly in arguing that complete respect for patients' autonomy reduces the physician from a moral agent to an extension of the patient's wishes. 36 Furthermore, they claimed that offering futile treatment may actually undermine patients' autonomy by making them believe there are choices when there are none.…”

“…[30][31][32][33][34][35][36][37][38] Paris and Reardon stated this view most clearly in arguing that complete respect for patients' autonomy reduces the physician from a moral agent to an extension of the patient's wishes. 36 Furthermore, they claimed that offering futile treatment may actually undermine patients' autonomy by making them believe there are choices when there are none. Brody argued that some territory on what he called the "moral island" of futility decisions must be reserved for professional integrity and that society cannot dictate to medical professionals the practice of their integrity.…”