Demands by Patients or their Families for treatment thought to be inappropriate by health care providers constitute an important set of moral problems in clinical practice. A variety of approaches to such cases have been described in the literature, including medical futility, standard of care and negotiation. Medical futility fails because it confounds morally distinct cases: demand for an ineffective treatment and demand for an effective treatment that supports a controversial end (e.g., permanent unconsciousness). Medical futility is not necessary in the first case and is harmful in the second. Ineffective treatment falls outside the standard of care, and thus health care workers have no obligation to provide it. Demands for treatment that supports controversial ends are difficult cases best addressed through open communication, negotiation and the use of conflict-resolution techniques. Institutions should ensure that fair and unambiguous procedures for dealing with such cases are laid out in policy statements.
Notes
Cites: Am J Respir Crit Care Med. 1997 Jan;155(1):15-209001282
Cites: Resuscitation. 1996 Nov;33(1):13-78959768
Cites: Can J Anaesth. 1995 Mar;42(3):186-917743566
Cites: CMAJ. 1998 Feb 24;158(4):491-39627562
Cites: BMJ. 1995 Mar 18;310(6981):683-47711528
Cites: JAMA. 1996 Aug 21;276(7):571-48709410
Cites: Am J Law Med. 1995;21(2-3):221-408571976
Cites: Am J Crit Care. 1995 Jul;4(4):280-57663591
Cites: J Law Med Ethics. 1995 Spring;23(1):20-67627298
Cites: Hum Health Care Int. 1996 Nov;12(4):168-7211660296
Cites: N Engl J Med. 1983 Sep 8;309(10):569-766877286
Cites: N Engl J Med. 1986 Nov 20;315(21):1347-513773957