Denying a Patient Life Saving Care

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 o

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de respiratory or aggressive care since it was medically and ethically inappropriate. The hospital was asking to treat according to its own principles. The court ruled that a hospital must provide treatment needed to prevent the material deterioration of a patient's emergency medical condition. Terms such as emergency medical condition were unclear, it was assumed that the absence of stabilizing treatment would result in a deterioration of bodily function. Application of these terms appears to be unsubstantiated, mechanical, and conclusory (Daar, 1995). Daar states that confusion exists because physicians and hospitals lack clearly defined policies with limits of treatment that they are willing to provide in any given circumstance. Courts and lawmakers have ill-defined policies which leaves them susceptible to patient claims for limitless treatment. In the case of Baby K, courts focused on an acute medical process and overlooked the patient's overall medical prognosis. Well-developed policies can alert patients, families, and physicians to the hospital's goals and expectations (pp. 221-240). Hospitals show empathy for the plight of physicians who are asked to compromise their professional conscience and act against their

Category: Government - D