Does professional autonomy protect medical futility judgments?

Bioethics

Volumn 20, Issue 2, 2006, Pages 92-104

  Gampel, Eric ^a  

^a CALIFORNIA STATE UNIVERSITY   (United States)

Author keywords

Autonomy; End of life; Rationing

Indexed keywords

ARTICLE; DECISION MAKING; FAMILY; HEALTH CARE PERSONNEL; HOSPITAL POLICY; HUMAN; MEDICAL PRACTICE; MEDICAL PROFESSION; MEDICINE; PATIENT; PHYSICIAN; PROFESSIONAL PRACTICE; RESOURCE MANAGEMENT; TREATMENT OUTCOME;

ANALYTICAL APPROACH; DEATH AND EUTHANASIA;

ADMINISTRATIVE PERSONNEL; CONSCIENCE; CONSENSUS; DECISION MAKING; DISSENT AND DISPUTES; ETHICAL ANALYSIS; GOALS; HOSPITALS; HUMANS; LIFE SUPPORT CARE; MEDICAL FUTILITY; ORGANIZATIONAL POLICY; PATERNALISM; PATIENTS; PERSONAL AUTONOMY; PHYSICIANS; PRACTICE GUIDELINES; PROBABILITY; PROFESSIONAL AUTONOMY; PROXY; QUALITY OF LIFE; REFUSAL TO TREAT; RESOURCE ALLOCATION; RISK ASSESSMENT; SOCIAL VALUES; VALUE OF LIFE; WITHHOLDING TREATMENT;

EID: 33644883616     PISSN: 02699702     EISSN: 14678519     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2006.00480.x     Document Type: Article

References (44)

1. Brody H. Bringing Clarity to the Futility Debate: Don't Use the Wrong Cases Camb Q Healthc Ethics 7 269 273
2. D. Can Medical Criteria Settle Priority Setting Debates? The Need for Ethical Analysis Health Care Anal 7 131 137
3. L.J. A.M. How Can Hospital Futility Policies Contribute to Establishing Standards of Practice Camb Q Healthc Ethics 9 524 531
4. BMA Resuscitation Council (UK), Royal College of Nursing. Decisions Relating to Cardiopulmonary Resuscitation J Med Ethics 27 310 316
5. L.J. N.S. Futility in Practice Arch Intern Med 153 437 441
6. R.D. A.S. J. The Problem with Futility N Engl J Med 326 560 1564
7. B.E. Futility and the Obligations of HCPs Bioethics 10 1 43 55
8. W. Judging Who Should Live: Schneiderman and Jecker On the Duty Not to Treat J Med Philos 23 500 515
9. R. Futility and the Goals of Medicine J Clin Ethics 9 194 205
10. R.D. Futility in Pediatrics: From Case to Policy J Clin Ethics 11 136 141
11. T. D. Futility and Hospital Policy Hastings Cent Rep 25 28 35
12. J.R. Use of the Medical Futility Rationale in Do-Not-Attempt- Resuscitation Orders JAMA 273 124 128
13. For instance, of 26 hospital futility policies in California, all mentioned procedures of dispute resolution, including reference to a role for an ethics committee. See Schneiderman & Capron, op. cit. note 2, p. 527.
14. The Shorter Oxford English Dictionary. 1965. London. Clarendon Press: 765.
15. L.J. N.S. A.R. Medical Futility: Its Meaning and Ethical Implications Ann Intern Med 112 949 954
16. J. The Illusion of Futility in Clinical Practice Am J Med 87 81 84
17. For instance, Tomlinson and Czlonka propose that attempted resuscitation is futile 'when it provides no meaningful possibility of extended life or other benefit for the patient', op. cit. note 6, p. 33. They urge not setting a precise standard of probability, on the grounds (among others) that the probabilities are too difficult to determine in specific cases, suggesting instead that it be left up to the individual HCP to determine whether a possibility, or the potential effects, are 'meaningful'.
18. J Med Philos 20 123 144
19. Schneiderman et al., op. cit. note 10, p. 951.
20. Ibid. p. 952; Truog, op. cit. note 6, p. 139.
21. This approach is defended in Wilson, op. cit. note 4, and Brody, op. cit. note 1. See also Tomlinson & Czlonka, op. cit. note 6, who urge the narrower concept for hospital policies.
22. J.W. S.V. Doing All They Can: HCPs Who Deny Medical Futility J Law Med Ethics 22 318 326
23. One recent study found that over a six-month period at two 400-bed hospitals, residents believed that the rationale of medical futility applied in 91 do-not-attempt-resuscitation orders, and that the concept of futility was used by the residents as the primary basis for six unilateral decisions to withhold treatments, when the patients were unable to communicate and no surrogate was available. Curtis et al., op. cit. note 7.
24. How HCPs Talk About Futility J Law Med Ethics 21 231 237
25. Wilson, op. cit. note 4, p. 50.
26. Brody, op. cit. note 1, p. 272.
27. Schneiderman & Capron, op. cit. note 2, p. 529.
28. Ibid.
29. N.G. Truth or Consequences N Engl J Med 338 913 915
30. J.S. Autonomy in the Medical Profession in the United Kingdom - an Historical Perspective Theor Med 21 409 423
31. An anonymous reviewer for this journal pointed out this worry.
32. E.D. Pellegrino & D.C. Thomasma. 1993. The Virtues in Medical Practice. New York. Oxford University Press: ch. 3.
33. Commentary: Bringing Clarity to the Futility Debate Camb Q Healthc Ethics 7 273 278
34. Truog, op. cit. note 6, p. 139.
35. Rhodes defends this point: op. cit. note 5, pp. 198-201.
36. T. H. Futility and the Ethics of Resuscitation JAMA 264 1278
37. Truog, op. cit. note 6, p. 139.
38. M.R. Conscientious Objection in Medicine Bioethics 14 3 205 227
39. Ibid. pp. 222-225.
40. Ibid. pp. 221-227.
41. L.J. Medical Futility: Its Meaning and Ethical Implications Ann Intern Med 112 949 954
42. As one author puts it, 'On this argument, doctors should stop providing treatment at the point where it becomes medically futile, in the name of both justice - which is satisfied by rewarding the most allocatively efficient techniques - and good clinical medicine'. Dickenson, op. cit. note 1, p. 133.
43. Solomon, op. cit. note 19.
44. Tomlinson & Brody, op. cit. note 30.