“Futile-care” ethics controversies generally involve doctors who want to withdraw or refuse wanted life-extending treatment they deem “inappropriate.” In reality, these interventions aren’t opposed because they don’t work, but because they do — they keep the patient alive when the doctor thinks that the patient would be better off expiring. Thus, these disputes actually involve value judgments rather than bona fide medical determinations.
There is another kind of “futile care” — known as “physiological futility”— in which doctors provide interventions that they know won’t work, but they do it anyway because the patient wants it. Doctors aren’t supposed to do that, but they sometimes do — such as when prescribing antibiotics for a viral infection even though the drugs only work against bacteria.
Still, I have never seen any medical society actually approve members providing useless interventions — until now. From a newly published opinion of the Ethics Committee of the American Society for Reproductive Medicine (my emphases):
Situations may arise where the clinician fairly determines that treatment has little or no chance of resulting in pregnancy and live birth, but the patient nonetheless requests it in order only to receive a psychological beneﬁt or to fulﬁll a religious belief. Beneﬁts such as resolving questions about their fertility, being able to have hope, obtaining closure, acting in accord with their faith, and knowing they tried assiduously can be valid goals for limited treatment. Thus, an unsuccessful outcome, while disappointing, may still bring beneﬁt from the patient’s perspective, although the amount of beneﬁt should be weighed carefully against the physical risks and costs of treatment.
The opinion blesses doctors refusing to provide such interventions, and one would hope so! But it also approves providing treatments that — remember — won’t work, to make the patient feel better:
The Ethics Committee also ﬁnds that clinicians may ethically offer treatments they deem to be physiologically futile in circumstances where the risks are minimal, and the understood goal of the patient is to receive a psychological beneﬁt from proceeding. In such a case, the patient’s general welfare may be enhanced by a limited attempt at treatment, a goal still compatible with the duty of beneﬁcence understood in its psychosocial dimension.
No. This comes close to quackery. It is to sanction taking advantage of desperate people — and not coincidentally, for a large payday — knowing that the patient is pursuing a hopeless course. And we can’t forget that some fertility interventions can have potentially risky side effects.
Patients retain fertility doctors to help them have babies, not provide “psychological benefits.” If a patient demands expensive and potentially risky interventions just to feel better, a referral to a psychologist or psychiatrist would seem to be the truly ethical approach. That’s called being a professional.
It also seems to me that it would be fraud if a doctor billed an insurance company or the government for providing what the doctor knows to be a physiologically futile intervention.
Public trust in institutions is eroding, including of our healthcare system. By authorizing doctors to knowingly provide (and be paid for) what are essentially non-treatments, the American Society for Reproductive Medicine adds gravity to that slide. The association should retract the opinion and reconsider its approach.
HT: Thaddeus Mason Pope.