SHOULD PHYSICIANS DETERMINE WHEN A PATIENT SHOULD BE
Who should have the final word in determining when a patient should be denied life saving care remains a topic of controversy. This paper describes the controversy and points out different perspectives from the physician, hospital, and patient/family.
Medical futility is a term that describes a situation where a patient demands and a physician objects to a provision of certain medical treatment, on the grounds that no medical benefit to the patient will be provided by the treatment. The U. S. Court of Appeals for the Fourth Circuit handed down a decision regarding the provision of nonbeneficial care (1994). The court stated that hospital physicians are obligated under the federal Emergency Medical Treatment and Active Labor Act (EMTALA) to provide treatment (ventilator support) to an anencephalic infant in the emergency room (Baby K). Physicians stated that this treatment was medically and ethically inappropriate. The physicians' medical judgment was overridden to accommodate the goals and desires of the patient's family. Federal law imposed a duty to provide treatment (Daar, 1995, pp. 221).
Futility has a different meaning for different people. Argument exists regarding the meaning of medical futility. Some state that futility has a precise meaning arguing that physicians have the right and responsibility to refuse to provide or even discuss, the use of futile therapy with patients or families. Others believe that this definition reflects the physicians' personal values and denies legitimate therapeutic choices to patients and families. The concept of medical futility is dependent on the assumption that it can be accurately predicted whether medical treatments will provide no benefit for a patient and should therefore be withheld. Continued debate regards the disagreement among different observers as to whether the predicted physiologic effect from a treat...