Medical futility: legal and ethical aspects.
- Aged
- Altruism*
- Beneficence*
- Decision Making*
- Disabled Persons
- Euthanasia, Passive*
- Family
- Freedom
- Humans
- Jurisprudence
What is medical futility?
What are the aspects of medical futility? “ Medical futility refers to interventions that are unlikely to produce any significant benefit to the patient: quantitative futility , where the likelihood that an intervention will benefit the patient is exceedingly poor, and qualitative futility , where the quality of benefit an intervention will produce is exceedingly
Is physiologic futility value-neutral?
“Medical futility refers to interventions that are unlikely to produce any significant benefit to the patient: quantitative futility, where the likelihood that an intervention will benefit the patient is exceedingly poor, and qualitative futility, where the quality of benefit an intervention will produce is exceedingly poor.” 4
What is the futility policy in medical ethics?
Abstract. "Medical futility" may be provisionally defined as a medical conclusion that a therapy is of no value to a patient and should not be prescribed. The current debate about medical futility is one of the most important and contentious in medical ethics. Proponents believe that allowing physicians to determine and withhold futile therapies can be done without disturbing the …
Can I get a full PDF of my medical futility conclusion?
Medical futility has both a quantitative and qualitative component. From the writings of the Hippocratic corpus 3 we derive a quantitative notion: “Whenever the illness is too strong for the available remedies, the physician surely must not expect that it can be overcome by medicine.”
What is an example of medical futility?
How is medical futility determined?
What is the principle of futility?
Why is medical futility an issue?
Which of the following best describe medical futility?
Is medical futility ethical?
What is a medical futility law?
What role does a declaration of futility play?
What is qualitative futility?
What medical ethics include?
What is moral distress?
What is medical futility?
I maintain that medical futility is the unacceptable likelihood of achieving an effect that the patient has the capacity to appreciate as a benefit. Both emphasized terms are important. A patient is neither a collection of organs nor merely an individual with desires. Rather, a patient (from the word “to suffer”) is a person who seeks the healing (meaning “to make whole”) powers of the physician. The relationship between the two is central to the healing process and the goals of medicine. Medicine today has the capacity to achieve a multitude of effects, raising and lowering blood pressure, speeding, slowing, and even removing and replacing the heart, to name but a minuscule few. But none of these effects is a benefit unless the patient has at the very least the capacity to appreciate it, a circumstance that is impossible if the patient is permanently unconscious.
What is futility in medical terms?
Another proposal is that the definition of medical futility should be limited to the unacceptable likelihood of achieving any physiological effect on the body. According to this proposal, the physician cannot regard a treatment as futile as long as it can maintain the function of any part of the body, such as pumping blood by means of cardiac compression, moving air by means of mechanical ventilation, or eliminating wastes via dialysis, even if the patient is permanently unconscious or in the last moments of a terminal condition. In short, the instruments of technology are the focus of attention rather than the patient. This definition, physiologic futility, has been presented as a “value neutral” definition. 11 That there are those who seriously advocate it illustrates how much modern medicine has lost its way, how much it has become fragmented by subspecialties and technology. To specify narrow physiological objectives as the goals of medical practice is not “value neutral,” but a value choice that is about as far from the patient-centered tradition of the medical profession as it is possible to be.
Why is it important to expand the futility debate?
I believe it is important that the futility debate, both in public and at the bedside, be expanded beyond “pull the plug” decisions to include more attention to improving doctors’ involvement in the details of end-of-life care, so that they do not say they have “nothing to offer” and walk away leaving the “nursing care” to nurses as seemingly beneath their attention. Patients and families who demand that “everything be done” may well be expressing a subtext: “Do not abandon me.”
What is futility policy?
Futility policies, like all institutional policies, attempt to bridge the gap between the cultures of medicine and the law–doctors trying to say legal things, lawyers trying to say medical things.
What is the limitation of life as a TV movie of the week?
A particularly important limitation, in this era of Life-as-a-TV-Movie of the Week, is that the physician does not owe the patient a miracle. Another proposed definition of medical futility has to do with the unacceptable likelihood of prolonging life.
What if a treatment has not worked in the last 100 cases?
Most of us probably would agree that if a treatment has not worked in the last 100 cases, almost certainly it is not going to work if it is tried again. (Statisticians can calculate that the upper limit of the 95% Confidence Interval is 3%.) The experience of 100 cases is attainable in many areas of medicine. This proposal is not an “objective” or “value-free” definition, but rather one that seeks reasonable consensus where absolute certainty is impossible and therapeutic benefit is the goal. If we can agree to call this treatment futile then the ordinary duty of the physician does not require offering it.
What is the relationship between medicine and the heart?
The relationship between the two is central to the healing process and the goals of medicine. Medicine today has the capacity to achieve a multitude of effects, raising and lowering blood pressure, speeding, slowing, and even removing and replacing the heart, to name but a minuscule few.
What is medical futility?
What is "medical futility"? "Medical futility" refers to interventions that are unlikely to produce any significant benefit for the patient. Two kinds of medical futility are often distinguished: Quantitative futility, where the likelihood that an intervention will benefit the patient is exceedingly poor, and.
What is futility in clinical practice?
Making a judgment of futility requires solid empirical evidence documenting the outcome of an intervention for different groups of patients. Futility establishes the negative determination that the evidence shows no significant likelihood of conferring a significant benefit. By contrast, treatments are considered experimental when empirical evidence is lacking and the effects of an intervention are unknown.
Why do we need futile intervention?
In some instances, it may be appropriate to continue temporarily to make a futile intervention available in order to assist the patient or family in coming to terms with the gravity of their situation and reaching closure. For example, a futile intervention for a terminally ill patient may in some instances be continued temporarily in order to allow time for a loved one arriving from another state to see the patient for the last time. However, futile interventions should not be used for the benefit of family members if this is likely to cause the patient substantial suffering, or if the family’s interests are clearly at odds with those of the patient.
What does "futile" mean in medical terms?
Instead, it refers to a particular intervention at a particular time, for a specific patient. For example, rather than stating, “It is futile to continue to treat this patient,” one would state, “CPR would be medically futile for this patient.”
What should physicians consider when making futility judgments?
Physicians should follow professional standards, and should consider empirical studies and their own clinical experience when making futility judgments. They should also show sensitivity to patients and families in carrying out decisions to withhold or withdraw futile interventions.
What is the ethical requirement for a patient to choose from among medically acceptable treatment options?
Although the ethical requirement to respect patient autonomy entitles a patient to choose from among medically acceptable treatment options (or to reject all options), it does not entitle patients to receive whatever treatments they ask for. Instead, the obligations of physicians are limited to offering treatments that are consistent with professional standards of care and that confer benefit to the patient.
What is qualitative futility?
Qualitative futility, where the quality of benefit an intervention will produce is exceedingly poor. Both quantitative and qualitative futility refer to the prospect that a specific treatment will benefit (not simply have a physiological effect) on the patient.
What is futility in medicine?
The medical futility debate is, at bottom, a conflict between respect for patient autonomy, on one hand, and physician beneficence and distributive justice, on the other. In seeking a balance between the values and goals of the patient and the values and goals of medicine, individual autonomy cannot be so inflated in importance as to destroy the principle of beneficence and overlook the equitable distribution of medical resources in society. To find the balance, physicians must reach a consensus on what constitutes a reasonable medical treatment, and patients and surrogates must restrict their self-advocacy to what is fair and equitable for all [21]. The reasonable treatment decision must center on the best interest of the patient, without failing to recognize that every individual is also a member of society. If a physician believes, after carefully onsidering the patient's medical status, values and goals, that a particular medical treatment is futile because it violates the principles of beneficence and justice, then the physician is ethically and professionally obligated to resist administering this treatment. The justification of medical treatments on the basis of weighing the benefits and burdens and the appropriate use of medical resources is firmly rooted in the Catholic moral tradition of the ordinary versus extraordinary means distinction.
Why do physicians need futility insurance?
For those physicians who are willing to risk litigation for the sake of preserving their professional integrity, a futility policy offers legal benefits. Although a futility policy will not insulate a physician from litigation, it should enable him or her to fashion a strong defense in a medical malpractice claim.
Why did patients and surrogates demand treatments that physicians believed were not in the best interest of the patient?
In the 1990s, patients and patient surrogates began demanding treatments that physicians believed were not in the best interest of the patient because they were medically futile and represented an irresponsible stewardship of health care resources. In legal cases such as Wanglie in 1991 and Baby K in 1994, the courts ruled in favor of the right of patients or their surrogates to request even those medical treatments from which physicians believed they would receive no medical benefit [3]. What has been problematic for the judges in these cases has been the lack of professional or institutional policies on medical futility against which they could judge physician and hospital compliance or noncompliance [4]. These complex cases have set the stage for the present debate over medical futility, which pits patient autonomy against physician beneficence and the allocation of social resources.
What cases did the courts rule in favor of the right of patients or their surrogates to request even those medical treatments
In legal cases such as Wanglie in 1991 and Baby K in 1994, the courts ruled in favor of the right of patients or their surrogates to request even those medical treatments from which physicians believed they would receive no medical benefit [3]. What has been problematic for the judges in these cases has been the lack of professional ...
What is the patient rights movement?
The patients' rights movement began as a reaction to the paternalism of physicians who unilaterally overtreated patients and prolonged their lives against their wishes or the wishes of their surrogate decision makers and family members . The perception of physician-driven overtreatment resulted in a series of legal cases ranging from the Quinlan case in 1976 to the Cruzan case in 1990, which gave patients or their appropriate surrogates the legal right to refuse medical treatment, even if doing so resulted in the patient's death. Despite physician or hospital administration arguments that treatment was appropriate, the courts ruled in favor of the patient's right to refuse treatment and the patient's surrogate's right to withhold treatment, generally on the condition that there was clear and convincing evidence that the patient would refuse life-sustaining treatment if he or she were conscious and able to do so.
Why do patients and surrogates have the right to request certain medical treatments?
Patients and surrogates make the ethical argument that, if they have the right to refuse or discontinue certain medical treatments on the basis of their best interest , they have the right to request certain medical treatments on that same basis. Physicians argue that many of the requested interventions are both burdensome for the patient and medically inappropriate because they fail to achieve the desired physiological effect and result in a misallocation of medical resources. Although providing these treatments can compromise physicians' professional integrity, many feel compelled to comply with the patient's or surrogate's wishes because they believe that society has mandated the provision of such interventions unless there is an agreement to withhold them [5]. The ever-present fear of litigation has not only fueled this debate, it has placed the very foundation of the patient-physician relationship in jeopardy.
Is medical futility new?
Despite its emergence as a dominant topic of discussion, especially as it applies to end-of-life care, the concept of medical futility is not new. Physicians at the time of Hippocrates recognized some medical conditions as impossible to cure and recommended no further treatment for those patients [1]. What has fueled the fires of the current ...
