Medical Futility
Michele Kirn
Xavier University
Introduction
Medical futility refers any medical treatment that is not likely to attain the preferred goal or has little chance for recovery or survival, which then justifies the reasoning not to provide treatment or withdraw life-lengthening treatment (Thompson, 2011). It refers to when medical treatment is more of a burden then therapeutic and when therapies are not valuable to patients (Robley, 2009). It allows health-care providers to claim a medical treatment as medically futile causing a treatment to be withdrawn or not to occur, not allowing the patients life to be extended because of medical support. This subject can be controversial on whether it is ethical to deem something medically futile. Should healthcare professionals allow patients or their surrogate decision makers to make the decision to prolong life or should the healthcare workers or ethics committee’s decision have the rights to deem something medically futile? On the side of patient or surrogate decision maker having the final say, one could argue this allows for patient autonomy and justice. This is especially apparent for patients who are disabled physically or mentally and do not have the competence to make their own decisions (Werth, 2005). However, non-maleficence and beneficence can be argued as well. Medical futility is apparent across all ages from the young to the old, especially in critical care and emergency situations. It is important for nurses and other caregivers to understand their side and impact on the outcome of patients. The purpose of this paper is to examine the different sides of medical futility.
Contextual Information
Medical futility is diffi...
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... life needs to be kept in mind and sometimes families might not understand or have different views because of cultural, religious, and spiritual reasons. Anger, guilt, sorrow and fear are some of the emotions that are going through the family and patients minds at this time. The healthcare workers need to keep this in mind and possibly allow medically futile treatments for a short amount of time to allow closure. However, if a treatment is only going to put more stress and pain on the patient and possibly even decrease their quality of life even more, I feel the patient would not want to hang on any longer. The healthcare team, especially nurses, have a large role in helping the family and patient understand this. Although this is a very controversial subject, families and healthcare workers can use ethical theoretical perspectives to come up with a moral decision.
As a result, life-sustaining procedures such as ventilators, feeding tubes, and treatments for infectious and terminal diseases are developing. While these life-sustaining methods have positively influenced modern medicine, they also inadvertently cause terminal patients extensive pain and suffering. Previous to the development of life-sustaining procedures, many people died in the care of their own home, however, today the majority of Americans take their last breath lying in a hospital bed. As the advancement of modern medicine continues, physicians and patients are going to encounter life-altering trials and tribulations. Arguably, the most controversial debate in modern medicine is the discussion of the ethical choice for physician-assisted suicide.
The ethical principle of nonmaleficence demands to first do no harm and in this case protect the patient from harm since she cannot protect. Nurses must be aware in situations such as this, that they are expected to advocate for patients in a right and reasonable way. The dilemma with nonmaleficence is that Mrs. Boswell has no chance of recovery because of her increasing debilitating mental incapability and the obvious harm that outweighs the intended benefits. If the decision were to continue treatment, suffering of the patient and family would be evident. Autonomy is the right to making own decisions and freedom to choose a plan of action. When making decisions regarding treatment of another person, it is important to respect the expressed wishes of the individual. John says that his mother would want to live as long as she could, but questions arise related to her quality of life and perception of prolonged suffering by prolonging the dying process. In BOOK states that quality of life changes throughout one’s life ...
...t’s family should be able decide for the patient whether or not prolonging their life is moral.
In A Tender Hand in the Presence of Death, Heather, the nurse, would put in IVs and feeding tubes in hopes of prolonging hospice care even when they were ineffective in order to give more time to the families who were having trouble letting go (MacFarquhar, 2016). In my personal situation, I can relate, as two of my grandparents have passed away from cancer and suffered for a long time before passing. Although it was incredibly sad and our families bargained for more time, there was some peace in knowing that the suffering had come to an end once they passed. For our own selfish reasons, we want as much time as possible with our loved ones who are suffering and close to death, but in reality, the decision for assisted suicide should only concern the individual whose life it
There is great debate in this country and worldwide over whether or not terminally ill patients who are experiencing great suffering should have the right to choose death. A deep divide amongst the American public exists on the issue. It is extremely important to reach an ethical decision on whether or not terminally ill patients have this right to choose death, since many may be needlessly suffering, if an ethical solution exists.
Unnoticed by the mainstream press, a disturbing study published in the Fall 2000 issue of the Cambridge Quarterly of Health Care Ethics reveals how far the futile-care movement, in reality the opening salvo in a planned campaign among medical elites to impose health-care rationing upon us, has already advanced. The authors reviewed futility policies currently in effect in 26 California hospitals. Of these, only one policy provided that "doctors should act to support the patient's life" when life-extending care is wanted. All but two of the hospital policies defined circumstances in which treatments should be considered nonobligatory even if requested by the patient or patient representative. In other words, 24 of the 26 hospitals permit doctors to unilaterally deny wanted life-supporting care.
The word ethics is derived from the Greek word ‘ethos’ meaning character or conduct. It is typically used interchangeably with word moral which is derived from the Latin word ‘moves’ which means customs or habits. Ethics refers to conduct, character and motivations involved in moral acts. Ethics are not imposed by a profession, by law but by moral obligation. It is unwritten code of conduct that encompasses both professional conduct and judgement. Ethics helps support autonomy and self-determination, protect the vulnerable and promotes the welfare and equality of human beings. An ethical dentist- patient relationship is based on trust, honesty, confidentiality, privacy and the quality of care.1
Powell and Lowenstein address many key issues about the refusal of life-saving treatments. They go into depth about what falls into this category of “life-saving treatments,” such as people refusing nutrition and hydration while they have a long life ahead of them with full cognitive ability. They aim to answer questions about whether doctors should allow patients to autonomously make these decisions as well as if the doctors have a duty to follow the patient's wishes. They also discuss the differences in cases with disabilities, chronic diseases, and other health problems along with where to draw the line about patient decisions. Not all of these decisions are the same and deeper understanding of the reasons behind the refusal need to be
Do terminally ill patients have the right to choose death with the assistance of others? Do religious and political leaders have the right to intervene with a patientís decision to die with the assistance of others? These two questions are some of the many about which this increasingly complex debate thrives. Society is often asked to answer each ques...
I personally feel that the life of a person is well above all policies and regulations and if an attempt to rescue him or her from death at the right time remains unfulfilled, it is not the failure of a doctor or nurse, it is the failure of the entire medical and health community.
This can be seen in the case study as ethical and legal arise in resuscitation settings, as every situation will have its differences it is essential that the paramedic has knowledge in the areas of health ethics and laws relating to providing health care. The laws can be interpreted differently and direction by state guidelines may be required. Paramedics face ethical decisions that they will be required to interpret themselves and act in a way that they believe is right. Obstacles arise such as families’ wishes for the patients’ outcome, communicating with the key stakeholders is imperative in making informed and good health practice decision. It could be argued that the paramedics in the case study acted in the best interest of the patient as there was no formal directive and they did not have enough information regarding the patients’ wishes in relation to the current situation. More consultation with the key stakeholders may have provided a better approach in reducing the stress and understanding of why the resuscitation was happening. Overall, ethically it could be argued that commencing resuscitation and terminating once appropriate information was available is the right thing to do for the
To save or not to save? That is the question. In the hospital setting, many problems arise and it is the duty of the healthcare workers to ensure, aide, and facilitate the patient’s well being to the best of their ability. Though all problems cannot simply be solved with medicine and therapy, it takes a considerate amount of critical thinking as well. What should happen when a problem like making sure a patient stays alive, backfires and the patient actually wants to die? Also, for a person desiring death, it is not considered righteous and we, as humans will deem them as mentally ill. This is where the ethical and moral issues of promoting health and respecting the patient’s right to autonomy are conflicted.
A divergent set of issues and opinions involving medical care for the very seriously ill patient have dogged the bioethics community for decades. While sophisticated medical technology has allowed people to live longer, it has also caused protracted death, most often to the severe detriment of individuals and their families. Ira Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center, believes too many Americans are “dying badly.” In discussing this issue, he stated, “Families cannot imagine there could be anything worse than their loved one dying, but in fact, there are things worse.” “It’s having someone you love…suffering, dying connected to machines” (CBS News, 2014). In the not distant past, the knowledge, skills, and technology were simply not available to cure, much less prolong the deaths of gravely ill people. In addition to the ethical and moral dilemmas this presents, the costs of intensive treatment often do not realize appreciable benefits. However, cost alone should not determine when care becomes “futile” as this veers medicine into an even more dangerous ethical quagmire. While preserving life with the best possible care is always good medicine, the suffering and protracted deaths caused from the continued use of futile measures benefits no one. For this reason, the determination of futility should be a joint decision between the physician, the patient, and his or her surrogate.
Physician-assisted suicide refers to the physician acting indirectly in the death of the patient -- providing the means for death. The ethics of PAS is a continually debated topic. The range of arguments in support and opposition of PAS are vast. Justice, compassion, the moral irrelevance of the difference between killing and letting die, individual liberty are many arguments for PAS. The distinction between killing and letting die, sanctity of life, "do no harm" principle of medicine, and the potential for abuse are some of the arguments in favor of making PAS illegal. However, self-determination, and ultimately respect for autonomy are relied on heavily as principle arguments in the PAS issue.
Rethinking Medical Ethics: A View from Below and Mountains beyond Mountains are two readings that will be further analyzed to demonstrate how re-socializing and re-humanizing medicine concurrently may be of importance to global health. As a recap, the former is a philosophical work that gives context to the idea of re-socialization in the medical field (Farmer). The latter is a literary, non-fictional piece that documents the life of Paul Farmer, from his early upbringing to his involvement with treating infectious diseases, from a third-person point of view (Kidder). From engagement with these readings, I have found the critical assessment of the upstream causes of health inequality as it pertains to a particular country's political, economic