Doctors' Values Are More Important Than Those of Their Patients
WHERE THE PHYSICIAN CONCLUDES THAT THE MINIMUM GOAL IS REALISTICALLY ACHIEVABLE BUT THAT TREATMENT SHOULD BE WITHHELD OR WITHDRAWN, that physician must consult with another physician... a. The physician who sought the consultation must advise the b. If there is still a demand or request for treatment, the physician must attempt to address the reasons directly and with a view to reaching consensus... c. If consensus cannot be reached, the physician must give the patient/proxy/representative a reasonable opportunity to identify another physician who is willing to assume care of the patient and must facilitate the transfer of care and... d. Where, despite all reasonable efforts, consensus cannot be reached the physician may withhold or withdraw life-sustaining treatment, but: i) in the case of a patient/proxy who is still not in agreement with the decision to withhold or withdraw treatment, the physician must provide at least 96 hours advance notice to the patient or proxy as described below.
I have been warning anyone who will listen about the coming huge policy fight over medical futility--what I call Futile Care Theory--that allows a doctor to refuse wanted life sustaining treatment when the doctor doesn't believe that the quality of the patient's life is worth sustaining (or spending money on). This isn't about asking for treatment that won't work, but withholding treatment that will or may work. Usually futile care protocols--where they have been promulgated--allow an ethics committee to make this decision after a quasi-judicial hearing. Texas has been a big center of futilitarian advances.
There is a futile care case right now in the courts of Winnipeg. In this regard, it is worth noting--and being very alarmed about--the futile care protocol adopted by The College of Physicians and Surgeons of Manitoba, which permits the doctor to make the call, after consultation with a second physician, without even having to pass it by an ethics committee. And this is in cases in which the minimal goal of the patient is likely to be met! From the protocol:
2. Where the consultation supports the conclusion that treatment should be withheld or withdrawn:
patient/proxy/representative that the consultation supports the initial assessment that treatment should be withheld or withdrawn .
This is the beginning of the institution of a duty to die that we ignore at our peril. It also threatens the trust of people in medicine. My prediction: A lot of fireworks ahead!
HT: Alex Schadenberg
Labels: Futile Care Theory
posted by Wesley J. Smith @ 5:00 PM
6 Comments
6 Comments:
It's been a busy week here in Houston - sorry I haven't been by to make people laugh at me lately.
Anyway -
How do they define "reasonable efforts" in the context of reaching a consensus when concerning the life of someone who *wants* to have live sustaining or possibly-live sustaning medical intervention?
And how do the doctors define "should" in this instance? "Should be withheld or withdrawn." According to what flow chart, what ethical decision-making team, according to what criteria?
This thing is bogus, man. Totally bogus. And I mean that in the original definition - a sham, a counterfeit, a deceit.
Welcome back, Tabs. Nobody laughs at you here. You add a lot to SHS.
I wish it were bogus and a sham. It is all too real and all too wrong.
What you propose, Wesley, is to force action against the conscience. This goes against the tradition of the First Principle of "do no harm." and is the beginning of greater injustices.
You aren't proposing that the doctor simply step away from the ventilator and allowing it to ventilate the lungs.
You ignore the constant need for manipulation - the required skilled, intentional actions - with technological intervention - and the increase of the technological interventions.
Further, the negation of conscience combined with forced action risks lives of those who are not dying.
No, I am suggesting that a doctor not abandon a patient. I am suggesting that it isn't up to him or her whether the time has come to end treatment in these cases. In any event, if these decisions are to be made they belong in open court and not between two colleagues or in a closed door ethics committee. I sm suggesting that when a lot of money was made in the ICU, patients complained about being hooked up to machines against their will. Now, that such actions cost money, we are hearing about futile care: no coincidence. I am suggesting that a doctor has the right to ask to be relieved from a case, as a lawyer does, but until that relief comes, he or she must act as doctors and not as priests.
...or as executioners! Let's face it, what they're proposing is that somebody who doesn't meet their definition of "worthwhile" can be killed for costing people money, which is the part that's a sham - they're feeding the public a lie that some people have more value than others. I bet if those same doctors were in the hospital getting needed care, they'd want their physicians to treat their requests for wanted treatments with dignity and respect and would be appalled if someone told them, "We feel that there's no justification for continuing this care, and since you and I can't reach a consensus on what to do, I'm going to over-ride you and have your feeding tube removed."
Appalled, and probably no little frightened.
doctors always had the liberty to not wanting to treat a patient if they don't feel it's necessary
a doctor doesn't have to do something which is morally/ethically against his will
for instance if a hypochondriac asks for a really expensive MRI scan would you give it to him/her?
furthermore with tests there's always false positives/negatives to take into account
the patient can always go to another doctor/hospital
hospitals are becoming more and more a business
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