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Collective Decisions About Medical Futility

Published online by Cambridge University Press:  01 January 2021

Extract

The debate about medical futility is no longer in its infancy. Scholarly literature on this seemingly intractable problem is voluminous. The list of widely publicized cases in which physicians have wanted to discontinue life-sustaining medical treatment that families demand has grown to include not just Helga Wanglie, but also Baby Rena, Baby L, Jane Doe, Joseph Finelli, Baby K, and Teresa Hamilton. A futility case has now been decided at the appellate court level.

Commentators have generated three kinds of proposals for resolving these conflicts. One group contends that the problem can be solved within the physician-patient-family relationship. While some in this group view professional authority broadly enough to warrant unilateral judgments by physicians that interventions desired by the patient or family should not be provided, others contend that physician authority does not extend that far, and that any resolution must be constrained by informed consent requirements.

Type
Article
Copyright
Copyright © American Society of Law, Medicine and Ethics 1994

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References

In re Conservatorship of Wanglie, No. PX-91-283 (Minn. Dist. Ct., Prob. Div. July 1, 1991).Google Scholar
Weiser, Benjamin, “A Question of Letting Go; Child's Trauma Drives Doctors to Reexamine Ethical Role,” The Washington Post, July 14, 1991, sec. A1.Google Scholar
Paris, John J. et al., “Physicians' Refusal of Requested Treatment: The Case of Baby L,” New England Journal of Medicine, 322 (1990): 1012–15.Google Scholar
Smothers, Ronald, “Atlanta Court Bars Effort to End Life Support for Stricken Girl,” The New York Times, Oct. 18, 1991, sec. A10.Google Scholar
Dew, Betty, “Do Those Who Cannot Speak Really Have a Voice?,” Law, Medicine & Health Care, 20 (1992): 316–19.Google Scholar
In the Matter of Baby K, 832 F. Supp. 1022 (E.D. Va. 93-68-A) aff'd 16 F.3d 590 (4th Cir. 1994).Google Scholar
New York Times News Service, “Parents Will Get Custody of Brain-Dead Girl,” The Chicago Tribune, Feb. 19, 1994, sec. 1:2.Google Scholar
In the Matter of Baby K, supra note 6.Google Scholar
Murphy, D.J., “Do-Not-Resuscitate Orders: Time for Reappraisal in Long-Term Care Institutions,” JAMA, 260 (1988): 20982101; Hackler, Chris, Hiller, Charles, “Family Consent to Orders Not to Resuscitate,” JAMA, 264 (1990): 1281-83; Tomlinson, Tom, Brody, Howard, “Futility and the Ethics of Resuscitation,” JAMA, 264 (1990): 1276-80; Tomlinson, Tom, Brody, Howard, “Ethics and Communication in Do-Not-Resuscitate Orders,” New England Journal of Medicine, 318 (1988): 43-46; Blackhall, L.J., “Must We Always Use CPR?,” New England Journal of Medicine, 317 (1987): 1281-85; Hammond, J., Ward, C.G., “Decision Not To Treat: ‘Do Not Resuscitate’ Order for the Burn Patient in the Acute Setting,” Critical Care Medicine, 17 (1989): 198-99; Schneiderman, Lawrence J., Jecker, Nancy S., “Medical Futility: Its Meaning and Ethical Implications,” Annals of Internal Medicine, 112 (1990): 949-54; and Paris, John J., “Pipes, Colanders, and Leaky Buckets: Reflections on the Futility Debate,” Cambridge Quarterly of Healthcare Ethics, 2 (1993): 147-49.Google Scholar
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.: U.S. Government Printing Office, 1983); Scheidermayer, D.L., “The Decision to Forego CPR in the Elderly Patient,” JAMA, 260 (1988): 2096-97; Zawacki, B., “Tongue-tied in the Burn Intensive Care Unit,” Critical Care Medicine, 17 (1988): 198-99; and Scofield, Giles R., “Is Consent Useful When Resuscitation Isn't?,” Hastings Center Report, 21 (1991): 28-36.Google Scholar
Daar, Judith F., “A Clash at the Bedside: Patient Autonomy v. A Physician's Professional Conscience,” Hastings Law Journal, 44 (1993): 1241–89.Google Scholar
Veatch, Robert M., Spicer, Carol Mason, “Medically Futile Care: The Role of the Physician in Setting Limits,” American Journal of Law & Medicine, 18 (1992): 1536; and Morreim, E. Haavi, “Profoundly Diminished Life: The Casualties of Coercion,” Hastings Center Report, 24 (1994): 33-42.Google Scholar
Callahan, Daniel, “Medical Futility, Medical Necessity: The Problem Without a Name,” Hastings Center Report, 21 (1991): 3035.Google Scholar
Youngner, Stuart, “Who Defines Futility?,” JAMA, 260 (1988): 2094–95.CrossRefGoogle Scholar
Brennan, Troyen A., “Physicians and Futile Care: Using Ethics Committees to Slow the Momentum,” Law, Medicine & Health Care, 20 (1992): 336–39.CrossRefGoogle Scholar
Mishkin, Douglas, “The Next Wanglie Case: The Problem of Litigating Medical Ethics,” The Journal of Clinical Ethics, 1 (1991): 282–85.Google Scholar
Schneiderman, Lawrence J., Jecker, Nancy, “Futility in Practice,” Archives of Internal Medicine, 153 (1993): 437–40.CrossRefGoogle Scholar
Fox, Ellen, Stocking, Carol, “Ethics Consultants' Recommendations for Life-Prolonging Treatment of Patients in a Persistent Vegetative State,” JAMA, 270 (1993): 2578–82.CrossRefGoogle Scholar
Weiser, , supra note 2.Google Scholar
Paris, et al., supra note 3.Google Scholar
Smothers, , supra note 4.Google Scholar
Schneiderman, , Jecker, , supra note 17.Google Scholar
In re Conservatorship of Wanglie, supra note 1.Google Scholar
In re Baby K, 832 F. Supp. 1022 (1993).Google Scholar
Emergency Medical Treatment and Active Labor Act, 42 U.S.C.A. 1395dd (West 1992).Google Scholar
In the Matter of Baby K, supra note 6.Google Scholar
New York Times News Service, supra note 7. But the language of the case suggests that the requirement applies only in cases involving a patient's refusal of recommended treatment: A health care provider wishing to override a patient's decision to refuse medical treatment must immediately provide notice to the State Attorney presiding in the circuit where the controversy arises, and to interested third parties known to the health care provider. The extent to which the State Attorney chooses to engage in a legal action, if any, is discretionary based on the law and the facts of each case. (In re: Matter of Patricia Dubreuil, No. 80, 311 Fla. S. Ct. 1993) (LEXIS, States Library, Florida File)Google Scholar
New York Times News Service, supra note 7.Google Scholar
Teresa Hamilton's father reported that he had beenGoogle ScholarGoogle Scholar
Knaus, W.A., Wagner, D.P., Lynn, J., “Short-Term Mortality Predictions for Critically Ill Hospitalized Adults: Science and Ethics,” Science, 254 (1991): 389–94.CrossRefGoogle Scholar
For example, Bopp, James Jr., Avila, Daniel, “Perspectives on Cruzan: The Sirens' Lure of Invented Consent: A Critique of Autonomy-Based Surrogate Decisionmaking for Legally-Incapacitated Older Persons,” Hastings Law Journal, 42 (1991): 779815; Bopp, James, “Reconciling Autonomy and the Value of Hit,” Journal of the American Geriatrics Society, 38 (1990): 600-02; and Bopp, James Jr., Avila, Daniel, “Trends in the Law: From Death to Life,” Idaho Law Review, 27 (1990): 1-35.Google Scholar
For example, Schneiderman, , Jecker, , supra note 17; and Brody, Howard, The Healer's Power (New Haven: Yale University Press, 1992).Google Scholar
Meisel, Alan, “The Legal Consensus About Forgoing Life-Sustaining Treatment: Its Status and its Prospects,” Kennedy Institute of Ethics Journal, 2 (1992): 309–45; Brennan, , supra note 15; and Nancy Neveloff Dubler, “Commentary: Balancing Life and Death—Proceed with Caution,” American Journal of Public Health, 83 (1993): 23-25.CrossRefGoogle Scholar
Council on Ethical and Judicial Affairs, American Medical Association, “Guidelines for the Appropriate Use of Do-Not-Resuscitate Orders,” JAMA, 265 (1991): 1868.CrossRefGoogle Scholar
One newspaper mentioned it in passing. See Weiser, Benjamin, “Who Should Decide When Treatment is Futile?,” The Washington Post, July 14, 1991, sec. A19.Google Scholar
Task Force on Ethics of the Society of Critical Care Medicine, “Consensus Report on the Ethics of Foregoing Life-Sustaining Treatments in the Critically Ill,” Critical Care Medicine, 18 (1990): 1435–39.Google Scholar
American Thoracic Society, “Withholding and Withdrawing Life-Sustaining Therapy,” Annals of Internal Medicine, 115 (1991): 478–85.CrossRefGoogle Scholar
Pearlman, R. A., Uhlmann, R. F., Cain, K. C., “Quality of Life in Chronic Diseases: Perceptions of Elderly Patients,” Journal of Gerontology, 43 (1988): M25M30; and Uhlmann, R.F., Pearlman, R.A., “Perceived Quality of Life and Preference for Life Sustaining Treatment in Older Adults,” Annals of Internal Medicine, 151 (1991): 495-97.CrossRefGoogle Scholar
Balch, Burke, “What is the Will to Live?,” National Right to Life News, 19 (1992): 11.Google Scholar
Caralis, P.V. et al., “The Influence of Ethnicity and Race on Attitudes Toward Advance Directives, Life-Prolonging Treatment and Euthanasia,” Journal of Clinical Ethics, 4 (1993): 155–65; and Special to the New York Times, “A Michigan Panel Backs Suicide Aid,” The New York Times, March 6, 1994, sec. 1:31.Google Scholar
Lundberg, George, “American Health Care System Management Objectives: The Aura of Inevitability Becomes Incarnate,” JAMA, 269 (1993): 2554–55; and Schneiderman, , Jecker, , supra note 17.CrossRefGoogle Scholar
“Hospitals Establish Policies to Limit Futile Care,” Hospital Ethics, 36 (1993): 1012.Google Scholar
Wolf, Susan M., “Ethics Committees and Due Process: Nesting Rights in a Community of Caring,” Maryland Law Review, 50 (1991): 798858; and Wolf, Susan M., “Toward a Theory of Process,” Law, Medicine & Health Care, 20 (1992): 278-90.Google Scholar
Veatch, , Spicer, , supra note 12.Google Scholar
Meyer, Harris, “Cost-Conscious Hospitals Set Futile Care Rules,” American Medical News, 36 (June 28, 1993): 20.Google Scholar
Havighurst, Clark C., “Prospective Self-Denial: Can Consumers Contract Today to Accept Health Care Rationing Tomorrow?,” University of Pennsylvania Law Review, 140 (1992): 17551808.CrossRefGoogle Scholar
Fox, Daniel M., Leichter, Howard M., “Rationing Health Care in Oregon: The New Accountability,” Health Affairs, 10 (1991): 727.Google Scholar
Daniels, Norman, “Is the Oregon Rationing Plan Fair?,” JAMA, 265 (1991): 2232–35; and Children's Defense Fund, An Analysis of the Impact of the Oregon Medicaid Reduction Waiver Proposal on Women and Children (Washington, D.C.: Children's Defense Fund, 1990).Google Scholar
Cardiopulmonary Resuscitation, O.C.G.A. 31-39-2 (1991); Orders Not to Resuscitate, N.Y. C.L.S. Pub. Health 2961 (1991); Scope and Limitations Regarding Life-Sustaining Treatment, N.J. Stat. 26:2H–67 (1992); and Health Care Decisions Act, Va. Code Ann. 54.1–2981 (1992).Google Scholar
Spielman, Bethany, “Invoking the Law in Ethics Consultation,” Cambridge Quarterly of Healthcare Ethics, 2 (1993): 457–67.CrossRefGoogle Scholar
Health Care Decisions Act, Va. Code Ann. 54.1–2981 (1992) (emphasis added); see also Medical Durable Power of Attorney, C.R.S. 15-14-506 (1993); Declarations Concerning Life-Sustaining Procedures, La. R.S 40:1299.58.1 (1992); and Health Care Decision Act, Md. Health-Gen. Code Ann. 5–6111 (1993).Google Scholar
Orders Not to Resuscitate, N.Y. C.L.S. Pub. Health 2961 (1991).Google Scholar
Cardiopulmonary Resuscitation, O.C.G.A. 31-39-2 (1991) (emphasis added).Google Scholar
Living Wills and Life Prolonging Procedures, Burns Ind. Code Ann. 16-36-4 (1993); Declarations, Life Support, R.S. Mo. 459.010 (1992); and Uniform Rights of the Terminally Ill Act, N.D. Cent. Code 23-06.4-02 (1993).Google Scholar
Durable Power of Attorney for Health Care, O.C.G.A. 31-36-1 (1990) (emphasis added).Google Scholar
Powers of Attorney for Health Care, 755 I.L.C.S. 45/4–10 (1986); Durable Power of Attorney for Health Care, Nev. Rev. St. Ann. 449.830 (1987); and Durable Power of Attorney Sample Form, H.R.S. 551D-2.6 (1988) (emphasis added).Google Scholar
Durable Power of Attorney for Health Care, O.C.G.A. 31-36-1 (1990).Google Scholar
The Fourth Circuit Court of Appeals observed correctly that Virginia's Health Care Decisions Act applies only to adults, not to infants such as Baby K. That fact would have been reason enough for finding Fairfax Hospital's appeal to Virginia's futility clause unpersuasive.Google Scholar
In the Matter of Baby K, supra note 6.Google Scholar
Brody, supra note 32.Google Scholar
Callahan, , supra note 13.Google Scholar
Task Force on Ethics of the Society of Critical Care Medicine, supra note 36.Google Scholar
Hicks, L. Wayne, “Life or Death: Health Officials are Pioneering Broad Guidelines to Prevent ‘Futile Care’ in Local Hospitals,” The Denver Business Journal, October 8, 1993, sec. 1:1; Hudson, Terese, “Are Futile-Care Policies the Answer? Providers Struggle with Decisions for Patients Near the End of Life,” Hospitals & Health Networks, 68 (1994): 2632; and Gianelli, Diane M., “One Committee Looks for Consensus on ‘Futile Care’,” American Medical News, 36 (Sept. 20, 1993): 10.Google Scholar