University of Washington Medical School Teaches Futile Care Theory as if the Right to Refuse Wanted Life-Sustaining Treatment Already Exists
An intrepid reader sent me this on-line syllabus from a bioethics course at the University of Washington Medical School. I checked on the link protocol and the author Nancy Jecker, Ph.D presumes that the right to refuse wanted life-sustaining treatment already exists. From the syllabus:While you will hear colleagues referring to particular cases or interventions as "futile", the technical meaning and moral weight of this term is not always appreciated. As you will make clinical decisions using futility as a criterion, it is important to be clear about the meaning of the concept.
The goal of medicine is to help the sick. You have no obligation to offer treatments that do not benefit your patients. Futile interventions are ill advised because they often increase a patient's pain and discomfort in the final days and weeks of life, and because they can expend finite medical resources.
Realize that futilitarians are changing the fundamental purpose of medicine to suit their beliefs. One such fundamental purpose is to extend life if that is what the patient wants. Futile Care Theory arrogantly presumes the right to tell a patient and his or her family that their life isn't worth extending--which is to say, that it isn't the treatment being judged "futile," but the patient. And, it apparently presumes the right to censor information a patient or family need to make proper informed consent.
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.
The futilitarians are acting as if they have already won this bioethical controversy. But their agenda is running into strong head winds. As failed attempts to impose medical futility in Texas--where there is a law explicitly permitting it--demonstrate, we the people are not going to just roll over and let ethics committees meeting behind closed doors decide when the time has come for their baby, grandma, or a spouse to die. The more public we make this fight, the better chance we have to stop this ad hoc health care rationing/medical discrimination in its tracks. After all, in this fight "choice" is on our side.
posted by Wesley J. Smith @ 8:44 AM
5 Comments
5 Comments:
Jecker is oft-cited in my papers. She never hides her bias.
The bias is one thing, but the smug presumption that the right already exists is another.
The genocide by the Nazis began with their withholding of food and medical care for "impaired" children and adults based on the concept of "life unworthy of life" (lebensunwertes Leben), in a society that felt they had limited resources. The concept of medical killing was later extended to the mass killings of the Jews in extermination camps.(See RJ Lifton's book "The Nazi Doctors")
This comment has been removed by the author.
Mr. Wesley Smith makes a passioned case for limitless patient autonomy. He also makes many assumptions the basis for which are not clear. He also argues using some irrelevant examples and analogies.
He makes the assertion that physicians readily accept the patient's refusal of treatment but do not agree to provide treatments that the patient demands. The right to refuse treatment has been accepted because a decisionally capable patient has control over his/her body. To operate on or give drugs to someone who does not want them is considered to be assault and battery. Most physicians use their persuasive powers to encourage patients to undertake treatments that they (the physician) consider appropriate, but they cannot force the patient to take the treatment.
On the otherhand, if the patient asks for a treatment that is known not to work, the physician should and often does refuse. There are many exmaples of this and most disagreements are resolved with simple clarifications regarding the physiology, pathology, pharmacology and the limits of medical science and technology.
The most contentious disputes arise in patients who are seriously ill and near death. In those situations many patients and families ask for measures like cardio-pulmonary resuscitation (CPR). CPR is a legitimate intervention but has significant limitations. In order to be effective, in order for the heart to start beating again, the body has to be in a reasonable state. In patients who are already undergointg maximum treatments to keep the cardiovascular system functioning CPR will not work. In those situations or if the liver, kidney and lungs are not functioning, the physicians do not do CPR because it will not work. Such decisions are not made lightly. Several experts look at possible ways of improving the patient's condition. If all agree that CPR will not work, only then is a Do Not Resuscitate (DNR) in order written after discussion with the patient and/or family.
A demand for CPR in those circumstances only adds to the patient and family's discomfort, pain and misery. It would be helpful if Mr. Smith and his friends would look at this issue carefully.
With regard to issues of cost and quality of life as deciding factors, I have to disagree with Mr. Smith. Quality of life may be brought up in the discussion but is not the deciding factor regarding CPR or other interventions and treatments.
With regard to cost, Mr. Smith is also forgetting that in most instances hospitals and doctors make money when a patient is in the Intensive Care Unit.
What does come into play is the availability of resources. If there is a shortage of beds the doctors are faced with a dilemma. Should they use the bed for a chronically ill patient or a young women who needs an I.C.U. bed after she has been hit by a drunk driver.
The role and authority of ethics committees is another major area that needs more discussion but I will leave it for another time.
I would very much like to engage in further discussions with Mr. Smith.
Post a Comment
Subscribe to Post Comments [Atom]
<< Home