Concerns About Decisions Related to Withholding/ Withdrawing Life-Sustaining Treatment and Futility for Persons With Disabilities

Abstract

Disability rights advocates have expressed significant concern about the potential dangers assisted suicide poses for persons with disabilities. This article extends this examination of concerns to withholding and withdrawing treatment in general and, in the specific case of physicians, using the futility rationale to discontinue or not start treatment. The arguments set forth against assisted suicide are applied to withholding and withdrawing treatment and futility and are shown to be at least as applicable to these other forms of hastening death. The article concludes with some policy suggestions.

The Right to Nutrition and Hydration: A Need for Vigilance

“…That being the case, the statement by her physicians that a feeding tube would be futile was not based upon physiological or objective futility but on a conception of qualitative futility that has been questioned both in the fields of medicine and disability rights (Noble, 1999;Veatch, 1994;Weijer, 1999;Werth, 2005). Qualitative futility is assessed through asking questions such as, ''Will the quality of life resulting from a medical intervention be so poor that the intervention does not actually benefit the person?''…”

Poverty: Not a Justification for Banning Physician‐Assisted Death

“…Another reason that financial pressures pose a greater threat to autonomy in decisions to limit care than in decisions to access PAD is that many, if not most, decisions to limit life‐sustaining treatment are made when patients are no longer competent . At best, a decision to withdraw life‐sustaining care is based on substituted judgment—presumption of what the patient would want, carried forward through advance directives or prior conversations with others.…”

“…If one is worried about the role that economic pressure plays in decisions at the end of life, should not the focus of concern about the potential for abuse be directed toward decisions to limit aggressive life-extending care and opt for palliative or hospice care rather than toward PAD, where the number of cases is smaller by many magnitudes and the amount saved per case is less? Another reason that financial pressures pose a greater threat to autonomy in decisions to limit care than in decisions to access PAD 47 is Plenty of evidence shows that aggressive life-sustaining care is costly in the United States and has the potential to place significant burdens on patients and their family members.…”