Lethality begets lethality

McCaffrey, Martin J.

doi:10.1038/jp.2011.52

Cited by 12 publications

(11 citation statements)

References 16 publications

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“…Other parents describe deep senses of disillusionment and anger at being misled by health professionals 14,15,43 . More significantly, perhaps, it has been argued that the term lethal is dangerous, as it contains concealed judgements about the quality of life of affected infants, and risks taking decisions out of the hands of women 44,45 …”

Section: The Language Of Lethalitymentioning

confidence: 99%

Fatally flawed? A review and ethical analysis of lethal congenital malformations

Wilkinson

Thiele

Watkins

et al. 2012

BJOG

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Prenatally diagnosed abnormalities that are associated with death in the newborn period are often referred to as 'lethal malformations'. Yet, for many of the commonly described lethal malformations long-term survival is possible if supportive interventions are provided. In this paper we analyse and review fetal or congenital lethal abnormalities. The designation 'lethal' overlaps with the concept of 'medical futility'. The term is used for a heterogenous group of conditions, and hinders clear communication and counselling. We argue that the term should be avoided, and propose in its place a set of key questions that should be addressed by counselling.

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Section: The Language Of Lethalitymentioning

confidence: 99%

Fatally flawed? A review and ethical analysis of lethal congenital malformations

Wilkinson

Thiele

Watkins

et al. 2012

BJOG

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“…As Martin McCaffrey writes, “As regards predicting a condition is lethal, potentially lifesaving treatments are withheld. As a result, patients who might have survived will then die, perpetuating the belief that the condition is lethal.”…”

Section: Objections To Lethalitymentioning

confidence: 99%

Who Is “Too Sick to Benefit”?

Courtwright¹

2012

Hastings Center Report

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Intensive care units provide focused, aggressive medical intervention to critically ill patients. Physicians responsible for ICU triage must decide which patients are sick enough to require this level of care and which can be managed on the general wards. While some patients are too well for the ICU, intensivists increasingly rely on another category, “too sick to benefit,” when denying ICU admission, even if beds are readily available. Recent studies indicate that between 19 and 37 percent of patients refused ICU admission were declined because they were thought too sick to benefit from it, suggesting that physician use of this category is common in ICU triage. The idea of being too sick to benefit may seem paradoxical given that ICUs exist to treat the sickest of the sick. There is, however, increasing awareness that some diseases progress despite maximal intervention. Although there have been systematic attempts to define these diseases—most notably during the medical futility debates of the 1980s and early 1990s—there is little evidence about which conditions make a patient too sick to benefit from ICU admission. In the absence of a clear understanding of which diseases progress despite maximal care, ICU triage under the category “too sick to benefit” is currently done on a case‐by‐case basis. Contemporary decisions about who is too sick to benefit thus raise a number of ethical issues about what constitutes standard of care, the role of health care providers' judgments of quality of life in triage, and the just allocation of resources. Addressing these ethical concerns requires us to better define the population of critically ill adults who are too sick to benefit—a conceptual and empirical project. In this article, I recommend employing a diagnostic concept from the neonatal literature: namely, a lethal disease.

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“…Jeg er også blitt fortalt, og har selv erfart, at det er vanlig å unnlate resuscitering av nyfødte med kjent alvorlig avvik (trisomi 13 og 18), samt å unngå all behandling da det vurderes som «dødsutset-tende». Studier viser at ved misdannelser i sentralnervesystemet avsluttes behandling hyppigere (16), i tilfeller der utviklingsavvik er kjent på forhånd, unnlater man oftest å behandle (14,17). I debatten rundt fosterdiagnostikk brukes kvinners autonomi som et av hovedargumentene.…”

Section: Vil Kvinnen Holdes Ansvarlig For Barnets Helsetilstand?unclassified

“…Idet kvinnen velger å baere frem barnet, derimot, fratas hun denne autonomien. Hun får ikke vaere med på avgjørelser om forløsning eller behandlingsnivå (10,14,17). Helsevesenet har ikke lenger tillit til at hun vet hva som er best for seg og sitt barn.…”

Section: Vil Kvinnen Holdes Ansvarlig For Barnets Helsetilstand?unclassified

Er tidlig ultralydundersøkelse for alle et gode?

Berg¹

2012

Tidsskriftet

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Lethality begets lethality

Cited by 12 publications

References 16 publications

Fatally flawed? A review and ethical analysis of lethal congenital malformations

Fatally flawed? A review and ethical analysis of lethal congenital malformations

Who Is “Too Sick to Benefit”?

Er tidlig ultralydundersøkelse for alle et gode?

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