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We Have All the Time in the World: The Law and Ethics of Time-Limited Interventions in Clinical Care
Published online by Cambridge University Press: 22 October 2024
Abstract
The authors consider the legal and ethical considerations of offering a time-limited trial of a potentially non-beneficial intervention in the setting of patient or surrogate requests to pursue aggressive treatment. The likelihood of an intervention’s success is rarely a zero-sum game, and an intervention’s risk-to-benefit ratio may be indiscernible without further information (often, a matter of time).
- Type
- Symposium Articles
- Information
- Journal of Law, Medicine & Ethics , Volume 52 , Issue 2: Defining Health Law for the Future: A Tribute to Professor Charity Scott , Summer 2024 , pp. 309 - 320
- Copyright
- © The Author(s), 2024. Published by Cambridge University Press on behalf of American Society of Law, Medicine & Ethics
References
Armstrong, L., “We Have All the Time in the World,” Track 1 on On Her Majesty’s Secret Service Soundtrack (Warner Bros., 1969): Record.Google Scholar
See Meisel, A., Jennings, B., and Doka, K. J. et al., eds., Ethics, End-of-Life Care, and the Law: Overview, in Living with Grief: Ethical Dilemmas at the End of Life (Better World Books, 2005): at 63.Google Scholar
McDermid, R. C. and Bagshaw, S. M., “Prolonging Life and Delaying Death: The Role of Physicians in the Context of Limited Intensive Care Resources,” Philosophy, Ethics, and Humanities in Medicine 4, no. 1 (2009): 3, available at <https://peh-med.biomedcentral.com/articles/10.1186/1747-5341-4-3#citeas%3E> (last visited June 18, 2024), citing J. P. Burns and R. D. Truog, “Futility: A Concept in Evolution,” Chest 132, no. 6 (2007): 1987–93, available at <https://journal.chestnet.org/article/S0012-3692(15)52476-8/abstract> (last visited June 18, 2024).Google ScholarPubMed
For the purpose of this paper, a “surrogate” refers to any person who makes decisions on behalf of a patient. A surrogate may be a health care agent designated in an advance directive, a decision-maker defined by statute, or a decision-maker appointed by a court (such as a guardian).Google Scholar
Cruzan by Cruzan v. Dir., Missouri Dep’t of Health, 497 U.S. 261, 262 (1990).Google Scholar
Under a “substituted judgment” standard, the surrogate attempts to determine, with as much accuracy as possible, what decision the patient would make if they were able to do so. Under a “best interests” standard, the surrogate considers the decision a reasonable person would make under the patient’s circumstances, considering the benefits and burdens of treatment.Google Scholar
Causey v. St. Francis Med. Ctr., 719 So. 2d 1072, 1075–76 (1998).Google Scholar
Id. (emphasis in original).Google Scholar
See,Google Scholar
Luce, J. M. and Alpers, A., “Legal Aspects of Withholding and Withdrawing Life Support from Critically Ill Patients in the United States and Providing Palliative Care to Them,” American Journal of Respiratory and Critical Care Medicine 162, no. 6 (2000): 2029–32, at 2029, available at <https://www.atsjournals.org/doi/10.1164/ajrccm.162.6.1-00> (last visited June 18, 2024).Google Scholar
See, e.g., Smith v. Finch, 285 Ga. 709, 711, 681 S.E.2d 147, 149 (2009) (citations omitted) (“To establish professional medical negligence the evidence presented by the patient must show a violation of the degree of care and skill required of a physician. Such standard of care is that which, under similar conditions and like circumstances, is ordinarily employed by the medical profession generally.”).Google Scholar
See Causey, 719 So. 22d, at 1076.Google Scholar
T.L. v. Cook Children’s Med. Ctr., 607 S.W.3d 9, 90 (Tex. App. 2020).Google Scholar
Bosslet, G. T., Pope, T. M., Rubenfeld, G D., Lo, B., Truog, R. D., Rushton, C. H., and Curtis, J. R. et al., “An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units,” American Journal of Respiratory and Critical Care Medicine 191, no. 11 (2015): 1318–30, at 1318, available at <https://www.atsjournals.org/doi/10.1164/rccm.201505-0924ST> (last visited June 18, 2024).CrossRefGoogle ScholarPubMed
Truog, R. D., “Is It Always Wrong to Perform Futile CPR?” NEJM 362, no. 6 (2010): 477–79, available at <https://www.nejm.org/doi/abs/10.1056/NEJMp0908464> (last visited June 18, 2024).Google ScholarPubMed
See Cook Children’s Med. Ctr., 607 S.W. 3d at 94 (citations and internal quotations omitted).Google Scholar
In Re Quinlan, 70 N.J. 10, 355 A.2d 647 (1976).Google Scholar
Id., at 651.Google Scholar
Id., at 669, citing Teel, K., “The Physician’s Dilemma. A Doctor’s View: What The Law Should Be,” Baylor Law Review 27 (1975): 6–9, at 8–9 (1975).Google ScholarPubMed
Id., at 671.Google Scholar
Id.,Google Scholar
Id., at n.10.Google Scholar
Cruzan, 497 U.S. 261, 281–82 (1990).Google Scholar
Miller ex rel. Miller v. HCA, Inc., 118 S.W.3d 758 (Tex. 2003).Google Scholar
Id. at 762.Google Scholar
Id., at 767–68.Google Scholar
Id., at 769.Google Scholar
See, e.g., Gilmore v. Finn, 259 V.A. 448 (2000); Schiavo ex rel. Schindler v. Schiavo, 403 F.3d 1289, 1291 (11th Cir. 2005).Google Scholar
In re Baby K,16 F.3d 590 (4th Cir. 1994).Google Scholar
Id. at 593.Google Scholar
Id. at 598.Google Scholar
TEX. HEALTH & SAFETY CODE ANN. § 166.046.Google Scholar
TEX. HEALTH & SAFETY CODE ANN. § 166.046(a-2).Google Scholar
TEX. HEALTH & SAFETY CODE ANN. § 166.046(d-2).Google Scholar
TEX. HEALTH & SAFETY CODE ANN. § 166.046(e).Google Scholar
TEX. HEALTH & SAFETY CODE ANN. § 166.046(a-2).Google Scholar
T.L. v. Cook Children’s Med. Ctr., 607 S.W.3d 9, 89–91 (Tex. App. 2020).Google Scholar
MD. CODE ANN. § 5-611(A) (LexisNexis 2023).Google Scholar
MD. CODE ANN. § 5-611(B) (LexisNexis 2023).Google Scholar
VA. CODE ANN. § 54.1-2990(B) (2023).Google Scholar
Defined as “any ongoing health care that utilizes mechanical or other artificial means to sustain, restore, or supplant a spontaneous vital function, including hydration, nutrition, maintenance medication, and cardiopulmonary resuscitation.”Google Scholar
For example, by causing aspiration.Google Scholar
VA. CODE ANN. § 54.1-2990(B)(2023)Google Scholar
Downer, K., Gustin, J., Lincoln, T., Goodman, L., and Barnett, M. D., “Communicating about Time-Limited Trials,” Chest 161, no. 1 (2022): 202–7, available at <https://journal.chestnet.org/article/S0012-3692(21)03843-5/abstract> (last visited June 18, 2024Google ScholarPubMed
Chang, D. W., Neville, T. H., Parrish, J., Ewing, L., Rico, C., Jara, L., and Sim, D. et al. “Evaluation of Time-Limited Trials among Critically Ill Patients with Advanced Medical Illnesses and Reduction of Nonbeneficial ICU Treatments,” JAMA Internal Medicine 181, no. 6 (June 1, 2021): 786–794, at 786, available at <https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2778535> (last visited June 18, 2024).Google ScholarPubMed
Schenker, Y., Tiver, G. A., Hong, S. Y., and White, D. B., “Discussion of Treatment Trials in Intensive Care,” Journal of Critical Care 28, no. 5 (October 2013): 862–69, at 867, available at <https://www.sciencedirect.com/science/article/abs/pii/S088394411300124X?via%3Dihub> (last visited June 18, 2024).Google ScholarPubMed
Downer, supra note 50, at 203.Google Scholar
“The Share Approach: A Model for Shared Decisionmaking — Fact Sheet.” AHRQ, available at <https://www.ahrq.gov/health-literacy/professional-training/shared-decision/tools/factsheet.html#:~:text=Shared%20decisionmaking%20occurs%20when%20a,the%20patient’s%20values%20and%20preferences> (last visited June 18, 2024).+(last+visited+June+18,+2024).>Google Scholar
Bruce, C. R., Liang, C., Blumenthal-Barby, J. S., Zimmerman, J., Downey, A., Pham, L., Theriot, L., Delgado, E. D., and White, D.. “Barriers and Facilitators to Initiating and Completing Time-Limited Trials in Critical Care,” Critical Care Medicine 43, no. 12 (2015): 2535–43, available at <https://journals.lww.com/ccmjournal/abstract/2015/12000/barriers_and_facilitators_to_initiating_and.3.aspx> (last visited June 18, 2024).Google ScholarPubMed
Vink, E. E., Azoulay, E., Caplan, A., Kompanje, E. J., and Bakker, J., “Time-Limited Trial of Intensive Care Treatment: An Overview of Current Literature” Intensive Care Medicine 44, no. 9 (2018): 1369–77, available at <https://link.springer.com/article/10.1007/s00134-018-5339-x> (last accessed May 9, 2024).Google ScholarPubMed
Downer, supra note 50, at 205.Google Scholar
Cheung, E. H., Cheung, Jonathan C., and Yip, Y., “Beyond Failure or Success: Reflections on the Ethical Justifications for Time-Limited Trial of Intensive Care,” Intensive Care Medicine 48, no. 7 (2022): 969–70, available at <https://link.springer.com/article/10.1007/s00134-022-06752-8> (last accessed May 9, 2024).Google ScholarPubMed