Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-05T04:19:09.051Z Has data issue: false hasContentIssue false
  • English
  • Français

Judging Medical Futility: An Ethical Analysis of Medical Power and Responsibility

Published online by Cambridge University Press:  29 July 2009

Nancy S. Jecker  and
Lawrence J. Schneiderman
Nancy S. Jecker
Affiliation:
the book review editor for Cambridge Quarterly of Healthcare Ethics, associate professor at the University of Washington'sDepartments of Medical History, and Ethics and Adjunct Assistant Professor at the University of Washington School of Law, Seattle
Lawrence J. Schneiderman
Affiliation:
a professor in the University of California San Diegodepartments of Community and Family Medicine and Medicine
Get access Rights & Permissions [Opens in a new window]

Extract

In situations where experience shows that a particular intervention will not benefit a patient, common sense seems to suggest that the intervention should not be used. Yet it is precisely in these situations that a peculiar ethic begins to operate, an ethic that Eddy calls “the criterion of potential benefit.” According to this ethic, “a treatment is appropriate if it might have some benefit.” Thus, the various maxims learned in medical school instruct physicians that “‘an error of commission is to be preferred to an error of omission,’ or ‘when in doubt, cut it out’ or ‘if but one patient is helped, then the treatment is worthwhile.’”

Type
Special Section: Beyond Autonomy
Information
Cambridge Quarterly of Healthcare Ethics , Volume 4 , Issue 1 , Winter 1995 , pp. 23 - 35
Copyright
Copyright © Cambridge University Press 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Eddy, DM. Medicine, money and mathematics. American College of Surgeons Bulletin 1992;77:36–49 (at 42).Google ScholarPubMed

2. See note 1. Eddy, . 1992:42.Google Scholar

3. American Medical Association, Council on Ethical and Judicial Affairs. Decisions near the end of life. Journal of the American Medical Association 1992;67:2229–33.Google Scholar

4. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Deciding to Forego Life-Sustaining Treatment. Washington, D.C.: Government Printing Office, 1983:44.Google Scholar

5. Society of Critical Care Medicine, Task Force on Ethics. Consensus report on the ethics of foregoing life-sustaining treatments in the critically ill. Critical Care Medicine 1990;18:1435–9.CrossRefGoogle Scholar

6. Hastings Center. Guidelines on the Termination of Life-sustaining Treatment and the Care of the Dying. Indianapolis: Indiana University Press, 1987.Google Scholar

7. American Medical Association, Council on Ethical and Judicial Affairs. Guidelines for the appropriate use of do-not-resuscitate orders. Journal of the American Medical Association 1991;265:1868–71.CrossRefGoogle Scholar

8. American Heart Association, Emergency Cardiac Care Committee and Subcommittees. Guidelines for cardiopulmonary resuscitation and emergency cardiac care, VII: ethical considerations in resuscitation. Journal of the American Medical Association 1992;268:2282–8.CrossRefGoogle Scholar

9. American Thoracic Society, Bioethics Task Force. Withholding and withdrawing life-sustaining therapy. Annals of Internal Medicine 1991;115:478–85.CrossRefGoogle Scholar

10. Schneiderman, LJ, Jecker, NS. Is the treatment beneficial, experimental or futile? submitted.Google Scholar

11. Tomlinson, T, Brody, H. Futility and the ethics of resuscitation. Journal of the American Medical Association 1990;264:1276–80.CrossRefGoogle Scholar

12. Brett, AS, McCullough, LB. When patients request specific interventions. New England Journal of Medicine 1986;315:1347–51.CrossRefGoogle ScholarPubMed

13. Paris, JJ, Reardon, FE. Physician refusal of requests for futile or ineffective interventions. Cambridge Quarterly of Healthcare Ethics 1992;2:127–34.CrossRefGoogle Scholar

14. Paris, JJ, Schreiber, MD, Statter, M, Arensman, R, Siegler, M. Beyond autonomy: physicians' refusal to use life-prolonging extracorporeal membrane oxygenation. New England Journal of Medicine 1993;329:354–7.CrossRefGoogle ScholarPubMed

15. Faber-Langendoen, K. Resuscitation of patients with metastatic cancer: is transient benefit still futile? Archives of Internal Medicine 1991;151:235–9.CrossRefGoogle ScholarPubMed

16. Schneiderman, LJ, Jecker, NS, Jonsen, AR. Medical futility: its meaning and ethical implications. Annals of Internal Medicine 1991;112:949–54.CrossRefGoogle Scholar

17. Schneiderman, LJ, Jecker, NS. The Wrong Medicine: The Pursuit of Futile Treatment. Baltimore: Johns Hopkins University Press (in press).Google Scholar

18. See note 10. Schneiderman, Jecker. Submitted.

19. Grimes, DA. Technology follies. Journal of the American Medical Association 1993;269:3030–3.CrossRefGoogle ScholarPubMed

20. Schoenbaum, SC. Towards fewer procedures and better outcomes. Journal of the American Medical Association 1993;269:794–6.CrossRefGoogle Scholar

21. Chalmers, TC. Ethical aspects of clinical trials. American Journal of Ophthalmology 1975;79:753–8.CrossRefGoogle ScholarPubMed

22. Jecker, NS, Schneiderman, LJ. Futility and rationing. American Journal of Medicine 1992;92:189–96.CrossRefGoogle ScholarPubMed

23. The Compact Edition of the Oxford English Dictionary. New York: Oxford University Press, 1984:1213.Google Scholar

24. See note 23. Oxford English Dictionary. 1984:1213.Google Scholar

25. See note 23. Oxford English Dictionary. 1984:1213–4.Google Scholar

26. See note 23. Oxford English Dictionary. 1984:1213.Google Scholar

27. See note 23. Oxford English Dictionary. 1984:1214.Google Scholar

28. Merchant, C. The Death of Nature. San Francisco: Harper & Row Publishers, 1980:193.Google Scholar

29. Benn, SI. Power. In: Edwards, P, ed. The Encyclopedia of Philosophy. Vol. 5. New York: Macmillan, 1972:424–7.Google Scholar

30. Osmond, H, Siegler, M. The sick role and Aesculapian authority. Alabama Journal of Medical Sciences 1980;17:197–201.Google ScholarPubMed

31. See note 23. Oxford English Dictionary. 1984:2121.Google Scholar

32. Weber, M. The social psychology of the world religions. In: Gerth, HH, Mills, CW. Max Weber: Essays in Sociology. New York: Oxford University Press, 1946:267–301.Google Scholar

33. Osmond, H. God and the doctor. New England Journal of Medicine 1980;302:555–8.CrossRefGoogle ScholarPubMed

34. Midgley, M. Science and Salvation. New York: Routledge, 1992:2.Google Scholar

35. See note 34. Midgley, . 1992:7.Google Scholar

36. Moser, HW. Lorenzo's oil. Lancet 1993;341:544.CrossRefGoogle ScholarPubMed

37. Aubourg, P, Adamsbaum, C, Lavallard-Rousseau, M Claude et al. , A two-year trial of oleic and erucic acids (‘Lorenzo's oil’) as treatment for adrenomyeloneuropathy. New England Journal of Medicine 1993;329:745–52.CrossRefGoogle Scholar

38. Rizzo, WB. Lorenzo's oil: hope and disappointment. New England Journal of Medicine 1993;329:801–2.CrossRefGoogle ScholarPubMed

39. Wong, V. Adrenoleukodystrophy in a Chinese boy. Brain Development 1992;14:276–7.CrossRefGoogle Scholar

40. See note 36. Moser, . 1993:544.Google Scholar

41. Zinkham, WH, Kickler, T, Borel, J, Moser, HW. Lorenzo's oil and thrombocytopenia in patients with adrenoleukodystrophy. New England Journal of Medicine 1993;328:1126–7.CrossRefGoogle ScholarPubMed

42. Unkrig, CJ, Schroder, R, Scharf, RE. Lorenzo's oil and lymphocytopenia [Letter]. New England Journal of Medicine 1994;330:577.Google Scholar

43. Chai, BC, Siminoski, K. Thrombocytopenia associated with use of Lorenzo's oil [Letter]. American Journal of Hematology 1993;44:290–1.CrossRefGoogle Scholar

44. See note 37. Aubourg, et al. 1993.Google Scholar

45. Brody, H. The Healer's Power. New Haven: Yale University Press, 1992:21.Google Scholar

46. Jecker, NS. Knowing when to stop. Hastings Center Report 1991;21:5–8.CrossRefGoogle Scholar

47. Ladd, J. Physicians and society: tribulations of power and responsibility. In: Spicker, SF, Healexy, JM, Engelhardt, HT, eds. The Law-Medicine Relation: A Philosophical Exploration. Boston: D. Reidel Publishing Company, 1981:33–52.CrossRefGoogle Scholar

48. Flatham, RE. Power, authority, and rights in the practice of medicine. In: Agich, GJ, ed. Responsibility in Health Care. Dordrecht: D. Reidel Publishing Co., 1982:105–25.CrossRefGoogle Scholar

49. McShea, RJ. How power corrupts. Journal of Value Inquiry 1978;12:37–48.CrossRefGoogle Scholar

50. Foucault, M. Discipline and Punishment. New York: Random House, 1979.Google Scholar

51. ten Have, H. How futility saved the live [sic] of medicine. European Philosophy of Medicine and Health Care 1993;1:30–3.Google Scholar

52. Wolf, S. Conflict between doctor and patient. Law, Medicine and Health Care 1988;16:197–203.CrossRefGoogle ScholarPubMed

53. Wolf, S. Near death—in the moment of decision. New England Journal of Medicine 1990;322:208–10.CrossRefGoogle Scholar

54. Veatch, RM, Spicer, CM. Medically futile care: the role of the physician in setting limits. American Journal of Law and Medicine 1992;18:15–36.Google ScholarPubMed

55. Ackerman, F. The significance of a wish. Hastings Center Report 1991;21:27–9.CrossRefGoogle ScholarPubMed

56. Angell, M. The case of Helga Wanglie. New England Journal of Medicine 1991;325:511–2.CrossRefGoogle ScholarPubMed

57. See note 56. Angell, . 1991:512.Google Scholar

58. Beauchamp, TL, Childress, JF. Principles of Biomedical Ethics, Third Edition.New York: Oxford University Press, 1989:72.Google Scholar

59. See note 17. Schneiderman, Jecker. In press.

60. Schneiderman, LJ, Jecker, NS. Futility in practice. Archives of Internal Medicine 1993;153:437–41.CrossRefGoogle ScholarPubMed

61. Lundberg, GD. American health care system management objectives: the aura of inevitability becomes incarnate. Journal of the American Medical Association 1993;269:2554–5.CrossRefGoogle ScholarPubMed

62. Stell, LK. Stopping treatment on grounds of futility: a role for institutional policy. Saint Louis University Public Law Review 1992;11:481–97.Google ScholarPubMed

63. Veatch, RM. Contemporary bioethics and the demise of modern medicine. In: Ormiston, GL, Sassower, R, eds. Prescriptions: The Dissemination of Medical Authority. New York: Greenwood Press, 1990:23–40.Google Scholar

64. Reiser, SJ, Dyck, AJ, Curran, WJ. Selections from the Hippocratic corpus. In: Reiser, S, Dyck, AJ, Curran, WJ, eds. Ethics in Medicine: Historical Perspectives and Contemporary Concerns. Cambridge, Massachusetts: Massachusetts Institute of Technology, 1985:5–10.Google Scholar

65. Jecker, NS, Pearlman, RA. Medical futility: who decides? Archives of Internal Medicine 1992;152:1140–4.CrossRefGoogle ScholarPubMed

66. Jecker, NS, Pearlman, RA. Medical futility [Letter]. Archives of Internal Medicine 1992;152:2505–6.CrossRefGoogle Scholar

67. See note 60. Schneiderman, Jecker. 1993;153:437–41.Google Scholar

68. Hackler, JC, Hiller, C. Family consent to orders not to resuscitate. Journal of the American Medical Association 1990;264:1281–3.CrossRefGoogle ScholarPubMed

69. See note 68. Hackler, Hiller. 1990:1282.Google Scholar

70. See note 68. Hackler, Hiller. 1990:1283.Google Scholar

71. Wanzer, SH, Adelstein, J, Cranford, RE et al. , The physician's responsibility toward hopelessly ill patients. New England Journal of Medicine 1984;310:955–9.CrossRefGoogle ScholarPubMed

72. Schneiderman, LJ, Faber-Langendoen, K, Jecker, NS. Beyond futility to an ethic of care. American Journal of Medicine 1994;96:110–4.CrossRefGoogle Scholar

73. See note 30. Osmond, Siegler. 1980:199.Google Scholar

74. Koch, KA, Meyers, BW, Sandroni, S. Analysis of power in medical decision-making: an argument for physician autonomy. Law Medicine and Health Care 1992;20:320–6.CrossRefGoogle ScholarPubMed

75. See note 47. Ladd, . 1981.Google Scholar

76. See note 54. Veatch, Spicer. 1992:27.Google Scholar

77. Baier, A. Trust and antitrust. Ethics 1986;96:231–60.CrossRefGoogle Scholar

78. Foucault, M. The Birth of the Clinic. New York: Vintage Books, 1975:84.Google Scholar

79. Maclntyre, A, quoted in Hauerwas, SM. Authority and the profession of medicine. In: Agich, GJ, ed. Responsibility in Health Care. Dordrecht, The Netherlands: D. Reidel Publishing Company, 1982:83–104.Google Scholar

80. Wittgenstein, L. Philosophical Investigations. New York: Oxford University Press, 1968:xi.Google Scholar

81. Parsons, T. Sociological Theory and Modern Society. New York: The Free Press, 1967.Google Scholar

82. Hiley, DR. Power and values in corporate life. Journal of Business Ethics 1987;6:343–53.CrossRefGoogle Scholar

83. Jecker, NS, Schneiderman, LJ. Medical futility: the duty not to treat. Cambridge Quarterly of Healthcare Ethics 1993;2:149–57.CrossRefGoogle Scholar