Medical Futility

It is useful to restrict the definition of futility to a medical determination, rather than a patient's conclusion. There are well established principles and laws supporting a patient's right to refuse therapies which she considers futile, disproportionately burdensome, or morally objectionable with or without the concurrence of her physician. The current debate focuses on the circumstance of a physician's conclusion that a therapy is futile, either absent a patient's own preference or in the face of a dissenting conclusion by a patient or proxy.

Brock D.W. Wartman S.A. , “When Competent Patients Make Irrational Choices.” New Engl J Med 1990; 322: 1595–1599.

Brett A.S. McCullough L.B. , “When Patients Request Specific Interventions: Defining the Limits of the Physician's Obligation.” N Engl J Med 1986; 315(21): 1347–1351; Center Hastings , Guidelines on the Termination of Life-Sustaining Treatment and the (lare of the Dying , Briarcliff Manor, NY 1987, p. 32; Tomlinson T. Brody H. , “Futility and the Ethics of Resuscitation”, JAMA 1990; 264(10): 1276–80; Youngner S.J. , “Futility in Context,” JAMA 1989; 264(10): 1295–96.

Paris J.J. Crone R.K. Reardon F. “Physician's Refusal of Requested Treatment: The Case of Baby L.” New Engl J Med 1990; 322(14): 1012–1015; Miles S.H. , “Informed Demand for Non-Beneficial Medical Treatment,” New Eng J Med 1991: 325; 512–15; Reid A. , “After Transplant, a Fight over Care,” Boston Sunday Globe , June 23, 1991, pp. A21,23; Ross L. , “Family Says Treatment Withheld,” Florida Times Union, May 23, 1991, pp. A1–2.

See Tomlinson , supra note 2; see Paris , supra note 3; Blackhall L. , “Must We Always Do CPR?” New Eng J Med 1987; 317(20): 1281–84; Braithwaite S. Thomasina D.C. , “New Guidelines on Foregoing Life-Sustaining Treatment in Incompetent Patients: An Anti-Cruelty Policy,” Annals Int Med 1986; 104: 711–15; Hackler C.J. Hiller F.C. , “Family Consent to Orders not to Resuscitate,” JAMA 1990; 264(10): 1281; Moore F.D. , “The Desperate Case: (Costs, Applicability, Research, Ethics),” JAMA 1989; 261(10): 1483–84.

Weiser B. , “A Question of Letting Go,” Washington Post, July 14, 1991, PP. A1, 18–19; Smothers R.D. , “Atlanta Court Bars Efforts to End Life Support for Stricken Girl, 13,” New York Times Oct. 18, 1991, p. A10; In re Doe, Super. Ct., Fulton Cnty, Ga. CAF D-93064.

See Tomlinson , supra note 2; Schneiderman L.J. Jecker N.S. Jonsen A.R. , “Medical Futility: Its Meaning and Ethical Implications,” Annals Int Med 1990; 112: 949–54.

Eckholm E. , “Patients and Insurers Clash on Therapy's Outer Limits,” New York Times, September 19, 1991, A1, A12.

See Tomlinson , supra note 2.

See Schneiderman , supra note 6.

Chervernak F.A. McCullough L.B. , “Justified Limits on Refusing Intervention,” Hastings Center Report 1991; 21(2): 12–17.

Pearlman R.A. Miles S.H. Arnold R.M. , “Empiric Research in Medical Ethics,” J Theoret Med 1991; Murphy D.J. Matchar D.B. , “Life-Sustaining Therapy: A Model for Appropriate Use,” JAMA 1990; 264: 2103–08; Knaus W.A. Wagner D.P. Lynn J. , “Short-Term Mortality Predictions for Critically Ill Hospitalized Adults: Science and Ethics,” Science 1991; 254;389–94.

See Schneiderman , supra note 6; Lantos J.D. Miles S.H. Silverstein M.D. , “Survival after Cardiopulmonary Resuscitation in Babies of Very Low Birth Weight,” New Eng J Med 1988; 318(2): 91–5; Youngner S.J. , “Who Defines Futility?” JAMA 1988; 260(14): 2094–5.

American Thoracic Society, “Withholding and Withdrawing Life-Sustaining Therapy,” Annals Int Med 1991; 115(6): 478–486; Task Force on Ethics, Society of Critical Care Medicine, “Consensus Report on the Ethics of Foregoing Life-Sustaining Treatments in the Critically Ill,” Critical Care Med 1990; 18: 1435–39.

See Schneiderman , supra note 6.

Council on Ethical and Judicial Affairs, AMA, “Guidelines for the Appropriate Use of Do-Not-Rcsuscitate Orders,” JAMA 1991; 265: 1868–71; Faber-Langendoen K. , “Resuscitation of Patients with Metastatic Cancer: Is Transient Benefit Still Futile?” Archives Int Med 1991; 151: 235–9.

See Miles , supra note 3.

See Hackler , supra note 4; see AMA, supra note 15; see Faber-Langendoen , supra note 15; Murphy D.J. , “Do-Not-Resuscitate Orders: Time for Reappraisal in Long-Term Care Institutions,” JAMA 1988; 260(14): 2098–2101; Taffett G.E. Teasdale T.A. Luchi R.J. , “In Hospital Cardiopulmonary Resuscitation,” JAMA 1988; 260: 2069–72.

Jecker N.S. , “Knowing When to Stop: The Limits of Medicine,” Hastings Center Report 1991; 21(3): 5–8; Amundsen D.W. , “The Physician's Obligation to Prolong Life: A Medical Duty without Classical Roots,” Hastings Center Report 1978; 8: 23–30; Kass L.R. , Toward a more Natural Science: Biology and Human Affairs, New York, Free Press, 1985; see also Tomlinson , supra note 4 and Schneiderman , supra note 6.

See Murphy , supra note 11.

Presidents Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forego Life-sustaining Treatment , US Government Printing Office, 1983, p.240; See Brock , supra note 1; Farber S.J. , “Ethics of Life Support and Resuscitation,” N Eng J M 1988; 318: 1757.

Callahan D. , “Medical Futility, Medical Necessity: The Problem-Without-A-Name,” Hastings Center Report 1991; 21(July): 30–35.

Callahan D. , Setting Limits: Medical Goals in an Aging Society. Simon and Schuster, New York, 1987.

See American Thoracic Society and Task Force on Ethics, supra note 13.

Applebaum G.E. King J.E. Finucane T.E. , “The Outcome of CPR Initiated in Nursing Homes,” J Am Geriatr Soc 1990; 38: 197–200; Council on Ethical and Judicial Affairs, AMA, Decisions Near the End of Life , 1991; see also Hacler , supra note 4; Lantos , supra note 12; and Taffett , supra note 17.

Miles S. H. Driscoll J. McCusker M. , “CPR in Nursing Homes: Policy and Clinical Realities,” Minnesota Med 1991; 74: 31–35; see also Taffett , supra note 17 and Applebaum , supra note 24.

See Tomlinson , supra note 2, Chervernak , supra note 10.

Department of Veterans Affairs, Withholding and Withdrawal of Life-Sustaining Treatment, M-2, Part I, Chapter 31.03.b(2).

See AMA, supra note 15.

See Taffett , supra note 17, and Braithwaite , supra note 4.

Angell M. , “The Case of Helga Wanglie. A New Kind (Right to Die) Case,” N Engl J Med. 1991; 325: 511–512.

See Hackler , supra note 4; Kass , supra note 18; and Applebaum , supra note 24.

Weber M. , The Development of Bureaucracy and its Relation to Law (translated from Wirtschaft und Gcsellshaaft , 1922) in Weber: Selections in Translation. Ed Runciman W.G. (trans by Mathews E. ) Cambridge University Press, 1978. p 351.

Lantos J.D. Singer P.A. Walker R.M. , “The Illusion of Futility in Clinical Practice,” Amer J Med 1989; 87: 81–84.

See Hackler , supra note 4.

See Blackhall , supra note 4.

See Tomlinson , supra note 2; Youngner , supra note 2; Murphy , supra note 11; and AMA, supra note 15.

Miles S.H. , “Between a Dream and a Poem: Relational Perspectives on the Wanglie Case,” Kennedy Inst Ethics J. 1992; 2(1): 61–72; see Farber, supra note 20; see Weber, supra note 43.

See Paris , supra note 3.

See Miles , supra note 3.

See Callahan , supra note 22.

Bellah R.N. Madsen R. Sullivan W.M. , The Good Society, Alfred A. Knopf, New York, 1991, pp. 10–11.

Ellul J. , The Technological Society, Vintage Books, 1964, New York.

Calabresi G. Bobbitt P. , Tragic Choices. Norton & Co. New York, 1978.

Aaron H. Schwartz W.B. , “Rationing Health Care: The Choice before Us,” Science 1990; 247: 418–422.

Danis M. Churchill L. , “Autonomy and the Common Weal,” Hastings Center Report 1991; 21(1): 25–32.

Bellah R.N. Madsen R. Sullivan W.M. , “Culture and Character” (pp. 2.7–39) in Habits of the Heart, University of California Press, 1985.

Berlin I. , “Two Concepts of Liberty,” and (from the Introduction) “Positive versus Negative Liberty,” in Four Essays on Liberty, Oxford University Press, 1969; 118–172, xxxvii-lv; see also Paris , supra note 3, and Chervernak , supra note 10.

Jonsen A. , “Bentham in a Box: Technology Assessment and Health Care Allocations,” Law Med Health Care 1986; 14: 172–174.

Veatch R.M. , “Justice and the Economics of Terminal Illness,” Hastings Center Report 1988; 18(4): 34–40; see also Brock , supra note 1; Murphy , supra note 11; and Farher, supra note 20.

See Ellul , supra note 41.

Olick R.S. , “Brain Death, Religious Freedom, and Public Policy: New Jersey's Landmark Legislative Initiative,” Kennedy Institute of Ethics Journal 1991; 1:4: 275–292.

Marsh F.H. Staver A. , “Physician Authority for Unilateral DNR orders,” J Legal Med 1991; 12: 115–165.

Brophy v. New England Sinai Hospital, 398 Mass. 417;497 NE 2d 626 (1986); see also Paris , supra note 3; Miles, supra note 3; Reid, supra note 3; Ross, supra note 3; Weiser, supra note 5; and Smothers, supra note 5.

Council on Ethical and Judicial Affairs, American Medical Association. Decisions to Forego Life-Sustaining Treatment for Incompetent Patients, 1991; sec also AMA, supra note 15; Faber-Langendoen, supra note 15; Jecker, supra note 18; and AMA, supra note 24.

See Paris , supra note 3; Miles, supra note 3; Hackler , supra note 4; and Schneiderman , supra note 6.