Human Exceptionalism

Doctors’ Values Are More Important Than Those of Their Patients

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:

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THE PHYSICIAN CONCLUDES THAT THE MINIMUM GOAL IS REALISTICALLY ACHIEVABLE BUT THAT TREATMENT SHOULD BE WITHHELD OR WITHDRAWN, that physician must consult with another physician…

2. Where the consultation supports the conclusion that treatment should be withheld or withdrawn:
a. The physician who sought the consultation must advise the

patient/proxy/representative that the consultation supports the initial assessment that treatment should be withheld or withdrawn .
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.

There you have it: Doctors think that their values should rule over those of their patients.

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

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