Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-06T13:16:53.518Z Has data issue: false hasContentIssue false

Futility, Autonomy, and Cost in End-of-Life Care

Published online by Cambridge University Press:  01 January 2021

Extract

In 1989, Helga Wanglie, 86 years old, broke her hip. This began a medical downhill course that a year later caused her health care providers to conclude that she would not benefit from continued medical treatment. It would be futile, and therefore, should not be provided. Her husband (the surrogate decision maker) disagreed, and the conflict eventually led to a lawsuit. The Wanglie case touched off an extended debate in the medical and bioethical literature about medical futility: what it means and how useful the concept is in making ethical decisions about starting or stopping treatment.

Type
Symposium
Copyright
Copyright © American Society of Law, Medicine and Ethics 2011

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

Cranford, R. E., “Helga Wanglie's ventilator,” Hastings Center Report 21, no. 4 (1991): 2324; Miles, S. H., “Autonomy's Responsibility: A Gloss on the Wanglie Affair,” Health Progress 72, no. 10 (1991): 30–1, 62.Google Scholar
Weijer, C. and Elliott, C., “Pulling the plug on futility,” BMJ 310, no. 6981 (1995): 683684.CrossRefGoogle Scholar
A common analogy used to explain this is the situation that arises when people dining out together decide in advance to split the check. Each person has an incentive to order a more expensive meal, yet the group as a whole must pay the total cost. If the check is to be evenly divided, it would be wise to agree to choose from a limited menu, i.e., to submit to some (non-price) rationing.Google Scholar
Pope, T. M., “Involuntary Passive Euthanasia in US Courts: Reassessing the Judicial Treatment of Medical Futility Cases,” Marquette Elder's Advisor 9, no. 2 (2008): 229268.Google Scholar
Jennings, B., Ryndes, T., D’Onofrio, C., and Baily, M. A., “Access to Hospice Care: Expanding Boundaries, Overcoming Barriers,” Hastings Center Report 33, no. 2, Special Supplement (2003): S3S59.Google Scholar
Institute of Medicine, To Err Is Human (Washington, D.C.: National Academy Press, 2000); Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century (Washington, D.C.: National Academy Press, 2001); McGlynn, E. A. et al., “The Quality of Health Care Delivered to Adults in the United States,” New England Journal of Medicine 348, no. 26 (2003): 2635–2645.Google Scholar
Institute for Healthcare Improvementsx, available at <http://www.ihi.org/ihi> (last visited February 24, 2011).+(last+visited+February+24,+2011).>Google Scholar
Robert Wood Johnson Foundation, available at <http://www.rwjf.org/> (last visited February 24, 2011); Kaiser Family Foundation, available at <http://www.kff.org/> (last visited February 24, 2011); Commonwealth Fund, available at <http://www.commonwealthfund.org/> (last visited February 24, 2011).+(last+visited+February+24,+2011);+Kaiser+Family+Foundation,+available+at++(last+visited+February+24,+2011);+Commonwealth+Fund,+available+at++(last+visited+February+24,+2011).>Google Scholar
Krauthammer, C., “The Truth about Death Counseling,” Washington Post, August 21, 2009.Google Scholar
President's Commission for the Study of Ethical Problems in Medicine, Chapter One, “An Ethical Framework for Access to Health Care,” in Securing Access to Health Care, Volume One: Report (Washington, DC: U.S. Government Printing Office, 1983).Google Scholar
In Kenneth Arrow's seminal article on health economics he notes that often a social policy that seems to be based on a concern for distributional justice is actually a policy that compensates for the inability of private insurance markets, including health insurance markets, to be able to provide people with the security they want in a world of uncertainty. Arrow, K. J., “Uncertainty and the Welfare Economics of Medical Care,” American Economic Review 53, no. 5 (1963): 941973, at 947.Google Scholar
Baily, M. A., “The Democracy Problem,” Hastings Center Report 24, no. 4 (1994): 39–42; Baily, M. A., “Defining the Decent Minimum,” in Chapman, A. R., ed., Health Care Reform: A Human Rights Approach (Washington, D.C.: Georgetown University Press, 1994): At 167–185; Baily, M. A., “Policies for the 1990's: Rationing Health Care,” in Arnould, R. J., Rich, R. F., and White, W. D., eds., Competitive Approaches to Health Care Reform (Washington, D.C.: Urban Institute Press, 1993): at 313–340.Google Scholar