The Physician's Role in Determining Futility

Brody, Howard

doi:10.1111/j.1532-5415.1994.tb06562.x

Cited by 31 publications

(15 citation statements)

References 4 publications

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“…They think that sometimes the physician may, in fact should, decide not to treat a patient, even if there's no triage, no problematic pregnancy, no question of not being compensated for services rendered, some possibility that death can be averted if treatment is administered, and certainty that death will occur if it is not. [1][2][3] Similar views can be found in papers by Schniederman, et al, and Miles. 4 5 (I shall be referring exclusively to the Brody articles reprinted in Mappes and DeGrazia throughout, however since they contain the clearest and most comprehensive defence of the position.…”

supporting

confidence: 69%

“…(1) is required to perform CPR for a patient whose empirical likelihood of regaining consciousness or of being discharged from the hospital alive is less than 1%; (2) is required to prescribe an antibiotic for a patient who, based on all appropriate diagnostic criteria, has a viral infection; (3) is required, or offers, to perform a cholecystectomy upon a patient with no detectable disease of the gallbladder; (4) offers to prescribe laetrile for a cancer patient; (5) offers to prescribe anabolic steroids for a weightlifter; (6) offers, or is required, to inject a lethal does of a drug as part of a state execution; (7) engages in a sexual relationship with a patient (Brody,3 pp 346-7).…”

mentioning

confidence: 99%

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Medical Futility and Physician Discretion

2007

Proceedings of the Twenty-First World Congress of Philosophy

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Some patients have no chance of surviving if not treated, but very little chance if treated. A number of medical ethicists and physicians have argued that treatment in such cases is medically futile and a matter of physician discretion. This paper critically examines that position. According to Howard Brody and others, a judgment of medical futility is a purely technical matter, which physicians are uniquely qualified to make. Although Brody later retracted these claims, he held to the view that physicians need not consult the patient or his family to determine their values before deciding not to treat. This is because professional integrity dictates that treatment should not be undertaken. The argument for this claim is that medicine is a profession and a social practice, and thus capable of breaches of professional integrity. Underlying professional integrity are two moral principles, one concerning harm, the other fraud. According to Brody both point to the fact that when the odds of survival are very low treatment is a violation of professional integrity. The details of this skeletal argument are exposed and explained, and the full argument is criticised. On a number of counts, it is found wanting. If anything, professional integrity points to the opposite conclusion.

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supporting

confidence: 69%

mentioning

confidence: 99%

Medical Futility and Physician Discretion

2007

Proceedings of the Twenty-First World Congress of Philosophy

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“…There has been much debate concerning what constitutes a futile action or intervention3 and who is qualified to make such a judgment 4. Whether an outcome is considered beneficent depends on the criteria used to define what constitutes doing good.…”

Section: What Is Futile Treatment?mentioning

confidence: 99%

Planning for a good death: responding to unexpected events

Saunders

Ross²,

Riley³

2003

BMJ

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When a terminally ill patient develops an acute problem, risky emergency treatment may seem futile to medical staff. But sometimes patients are not ready to die. What is a good death in such circumstances and how do we achieve it?In palliative care we aim to provide good symptom control and ultimately a good death. Patients and their families need time to prepare for death. Sometimes acute situations arise that can interfere with this process, leading to a distressing and undignified end. Decision making in emergency situations is difficult. We use a case history to illustrate the problems surrounding such decisions. Case historyA 19 year old man was diagnosed with rhabdomyosarcoma of the prostate with lung metastases and bone marrow disease. He was treated with four chemotherapeutic regimens. Although the pulmonary metastases completely resolved, the disease progressed at the primary site and regional lymph nodes. He had multiple complications from the chemotherapy, which resulted in lengthy hospital admissions. Controlling his pain, particularly neuropathic pain in his left leg, was difficult.He had many plans for the future and promising career prospects ahead of him. Despite several attempts, we were unable to open a discussion with him about his prognosis or end of life issues in the days preceding the emergency event.While he was an inpatient on the palliative care ward at the tertiary referral unit he developed intermittent melaena sufficient to require blood transfusion. Gastroscopy showed no abnormality. Angiography was arranged for the following day at a nearby hospital to locate the bleeding point. That evening, however, the rate of bleeding became catastrophic, and an immediate decision had to be made about his management. He was transfused with large volumes of blood products. By midnight, it was clear that he would die without further intervention. At this point he was fully alert and oriented, aware of what was happening and of the consequences of continued blood loss.Staff from different disciplines were present-an oncology registrar and senior house officer, a haematology registrar, a surgical registrar, a palliative care consultant, and ward nursing staff. In addition the oncology, surgical, and anaesthetic consultants were contacted at home for advice. Both the patient's parents were present.The nearby hospital was unable to perform angiography and embolisation that night because it had no critical care beds available. By 3 am we had found another hospital with facilities to perform the procedure, but it was several miles away. Our patient was faced with a traumatic and frightening death. The dilemma was whether to sedate him on the ward or take the risks of transferring him to another unit for a potentially life saving procedure, despite the terminal phase of his illness. What is a good death?In terminally ill patients it is not only quality of life that is important but the concept of a good death. 1Steinhauser et al evaluated factors considered important at the end of life from the perspect...

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“…Providing futile medical treatment may cause un-necessary harm to a patient; the principle of justice provides an ethical duty to physician not to administer such futile therapy [31]; additionally, requests of nursing staff to provide care that they feel is contrary to the best interests of the patient compromises their professional integrity and can result in conflicts within the health care team [32]; finally, in a situation of limited resources (such as ICU beds), physicians have a duty to appropriately allocate these resources to patients who may benefit from them [33].…”

Section: Refining Ethics Educational Objectivesmentioning

confidence: 99%

Ethical Issues in Patients with Leukemia: Practice Points and Educational Topics for the Clinical Oncologist and Trainees

Farroni¹,

Thompson²,

Arif³

et al. 2017

J Clin Res Bioeth

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Leukemia represents a complex spectrum of malignancies, involving numerous treatment options and substantial symptom burden for patients. Ethical dilemmas may arise which challenge a physician's clinical management and the patient's goals of care. What is needed is the systematic analysis of the most common issues that confront clinical teams treating patients with leukemia in order to derive best ethical practices for optimized patient care. We examined 312 formal ethics consultations requested for patients with a leukemia diagnosis. We found that the most common ethical issues relate to the level of appropriate intervention, the futility of treatment and surrogate decisionmaking. The underlying causes stem from inadequately addressed psychosocial issues, disagreements between various stakeholders in the patient's care and miscommunication. Illuminating these issues provides areas of focus for the practitioner to refine their practice and inform educational initiatives. The integration of the clinical ethics service into the multidisciplinary team is a mechanism to foster a preventative ethics model and mitigate potential dilemmas.

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The Physician's Role in Determining Futility

Cited by 31 publications

References 4 publications

Medical Futility and Physician Discretion

Medical Futility and Physician Discretion

Planning for a good death: responding to unexpected events

Ethical Issues in Patients with Leukemia: Practice Points and Educational Topics for the Clinical Oncologist and Trainees

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