Collective Decisions about Medical Futility

In re Conservatorship of Wanglie, No. PX-91-283 (Minn. Dist. Ct., Prob. Div. July 1, 1991).

Weiser Benjamin , “A Question of Letting Go; Child's Trauma Drives Doctors to Reexamine Ethical Role,” The Washington Post, July 14, 1991, sec. A1.

Paris John J. , “Physicians' Refusal of Requested Treatment: The Case of Baby L,” New England Journal of Medicine, 322 (1990): 1012–15.

Smothers Ronald , “Atlanta Court Bars Effort to End Life Support for Stricken Girl,” The New York Times, Oct. 18, 1991, sec. A10.

Dew Betty , “Do Those Who Cannot Speak Really Have a Voice?,” Law, Medicine & Health Care, 20 (1992): 316–19.

In the Matter of Baby K, 832 F. Supp. 1022 (E.D. Va. 93-68-A) aff'd 16 F.3d 590 (4th Cir. 1994).

New York Times News Service, “Parents Will Get Custody of Brain-Dead Girl,” The Chicago Tribune, Feb. 19, 1994, sec. 1:2.

In the Matter of Baby K, supra note 6.

Murphy D.J. , “Do-Not-Resuscitate Orders: Time for Reappraisal in Long-Term Care Institutions,” JAMA, 260 (1988): 2098–2101; Hackler Chris Hiller Charles , “Family Consent to Orders Not to Resuscitate,” JAMA, 264 (1990): 1281–83; Tomlinson Tom Brody Howard , “Futility and the Ethics of Resuscitation,” JAMA, 264 (1990): 1276–80; Tomlinson Tom Brody Howard , “Ethics and Communication in Do-Not-Resuscitate Orders,” New England Journal of Medicine, 318 (1988): 43–46; Blackhall L.J. , “Must We Always Use CPR?,” New England Journal of Medicine, 317 (1987): 1281–85; Hammond J. Ward C.G. , “Decision Not To Treat: ‘Do Not Resuscitate’ Order for the Burn Patient in the Acute Setting,” Critical Care Medicine, 17 (1989): 198–99; Schneiderman Lawrence J. Jecker Nancy S. , “Medical Futility: Its Meaning and Ethical Implications,” Annals of Internal Medicine, 112 (1990): 949–54; and Paris John J. , “Pipes, Colanders, and Leaky Buckets: Reflections on the Futility Debate,” Cambridge Quarterly of Healthcare Ethics, 2 (1993): 147–49.

President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forego Life-Sustaining Treatment (Washington, D.C.: U.S. Government Printing Office, 1983); Scheidermayer D.L. , “The Decision to Forego CPR in the Elderly Patient,” JAMA, 260 (1988): 2096–97; Zawacki B. , “Tongue-tied in the Burn Intensive Care Unit,” Critical Care Medicine, 17 (1988): 198–99; and Scofield Giles R. , “Is Consent Useful When Resuscitation Isn't?,” Hastings Center Report, 21 (1991): 28–36.

Daar Judith F. , “A Clash at the Bedside: Patient Autonomy v. A Physician's Professional Conscience,” Hastings Law Journal, 44 (1993): 1241–89.

Veatch Robert M. Spicer Carol Mason , “Medically Futile Care: The Role of the Physician in Setting Limits,” American Journal of Law & Medicine, 18 (1992): 15–36; and Haavi Morreim E. , “Profoundly Diminished Life: The Casualties of Coercion,” Hastings Center Report, 24 (1994): 33–42.

Callahan Daniel , “Medical Futility, Medical Necessity: The Problem Without a Name,” Hastings Center Report, 21 (1991): 30–35.

Youngner Stuart , “Who Defines Futility?,” JAMA, 260 (1988): 2094–95.

Brennan Troyen A. , “Physicians and Futile Care: Using Ethics Committees to Slow the Momentum,” Law, Medicine & Health Care, 20 (1992): 336–39.

Mishkin Douglas , “The Next Wanglie Case: The Problem of Litigating Medical Ethics,” The Journal of Clinical Ethics, 1 (1991): 282–85.

Schneiderman Lawrence J. Jecker Nancy , “Futility in Practice,” Archives of Internal Medicine, 153 (1993): 437–40.

Fox Ellen Stocking Carol , “Ethics Consultants' Recommendations for Life-Prolonging Treatment of Patients in a Persistent Vegetative State,” JAMA, 270 (1993): 2578–82.

Weiser , supra note 2.

Paris , supra note 3.

Smothers , supra note 4.

Schneiderman Jecker , supra note 17.

In re Conservatorship of Wanglie, supra note 1.

In re Baby K, 832 F. Supp. 1022 (1993).

Emergency Medical Treatment and Active Labor Act, 42 U.S.C.A. 1395dd (West 1992).

In the Matter of Baby K, supra note 6.

New York Times News Service, supra note 7. But the language of the case suggests that the requirement applies only in cases involving a patient's refusal of recommended treatment: A health care provider wishing to override a patient's decision to refuse medical treatment must immediately provide notice to the State Attorney presiding in the circuit where the controversy arises, and to interested third parties known to the health care provider. The extent to which the State Attorney chooses to engage in a legal action, if any, is discretionary based on the law and the facts of each case. (In re: Matter of Patricia Dubreuil, No. 80, 311 Fla. S. Ct. 1993) (LEXIS, States Library, Florida File)

New York Times News Service, supra note 7.

contacted by many people who ‘recovered’ after being declared brain dead and who urged him not to lose hope. Id.

Knaus W.A. Wagner D.P. Lynn J. , “Short-Term Mortality Predictions for Critically Ill Hospitalized Adults: Science and Ethics,” Science, 254 (1991): 389–94.

For example, Bopp James Jr. Avila Daniel , “Perspectives on Cruzan: The Sirens' Lure of Invented Consent: A Critique of Autonomy-Based Surrogate Decisionmaking for Legally-Incapacitated Older Persons,” Hastings Law Journal, 42 (1991): 779–815; Bopp James , “Reconciling Autonomy and the Value of Hit,” Journal of the American Geriatrics Society, 38 (1990): 600–02; and Bopp James Jr. Avila Daniel , “Trends in the Law: From Death to Life,” Idaho Law Review, 27 (1990): 1–35.

For example, Schneiderman Jecker , supra note 17; and Brody Howard , The Healer's Power (New Haven: Yale University Press, 1992).

Meisel Alan , “The Legal Consensus About Forgoing Life-Sustaining Treatment: Its Status and its Prospects,” Kennedy Institute of Ethics Journal, 2 (1992): 309–45; Brennan , supra note 15; and Nancy Neveloff Dubler, “Commentary: Balancing Life and Death—Proceed with Caution,” American Journal of Public Health, 83 (1993): 23–25.

Council on Ethical and Judicial Affairs, American Medical Association, “Guidelines for the Appropriate Use of Do-Not-Resuscitate Orders,” JAMA, 265 (1991): 1868.

One newspaper mentioned it in passing. See Weiser Benjamin , “Who Should Decide When Treatment is Futile?,” The Washington Post, July 14, 1991, sec. A19.

Task Force on Ethics of the Society of Critical Care Medicine, “Consensus Report on the Ethics of Foregoing Life-Sustaining Treatments in the Critically Ill,” Critical Care Medicine, 18 (1990): 1435–39.

American Thoracic Society, “Withholding and Withdrawing Life-Sustaining Therapy,” Annals of Internal Medicine, 115 (1991): 478–85.

Pearlman R. A. Uhlmann R. F. Cain K. C. , “Quality of Life in Chronic Diseases: Perceptions of Elderly Patients,” Journal of Gerontology, 43 (1988): M25–M30; and Uhlmann R.F. Pearlman R.A. , “Perceived Quality of Life and Preference for Life Sustaining Treatment in Older Adults,” Annals of Internal Medicine, 151 (1991): 495–97.

Balch Burke , “What is the Will to Live?,” National Right to Life News, 19 (1992): 11.

Caralis P.V. , “The Influence of Ethnicity and Race on Attitudes Toward Advance Directives, Life-Prolonging Treatment and Euthanasia,” Journal of Clinical Ethics, 4 (1993): 155–65; and Special to the New York Times, “A Michigan Panel Backs Suicide Aid,” The New York Times, March 6, 1994, sec. 1:31,

Lundberg George , “American Health Care System Management Objectives: The Aura of Inevitability Becomes Incarnate,” JAMA, 269 (1993): 2554–55; and Schneiderman Jecker , supra note 17.

“Hospitals Establish Policies to Limit Futile Care,” Hospital Ethics, 36 (1993): 10–12.

Wolf Susan M. , “Ethics Committees and Due Process: Nesting Rights in a Community of Caring,” Maryland Law Review, 50 (1991): 798–858; and Wolf Susan M. , “Toward a Theory of Process,” Law, Medicine & Health Care, 20 (1992): 278–90.

Veatch Spicer , supra note 12.

Meyer Harris , “Cost-Conscious Hospitals Set Futile Care Rules,” American Medical News, 36 (June 28, 1993): 20.

Havighurst Clark C. , “Prospective Self-Denial: Can Consumers Contract Today to Accept Health Care Rationing Tomorrow?,” University of Pennsylvania Law Review, 140 (1992): 1755–1808.

Fox Daniel M. Leichter Howard M. , “Rationing Health Care in Oregon: The New Accountability,” Health Affairs, 10 (1991): 7–27.

Daniels Norman , “Is the Oregon Rationing Plan Fair?,” JAMA, 265 (1991): 2232–35; and Children's Defense Fund, An Analysis of the Impact of the Oregon Medicaid Reduction Waiver Proposal on Women and Children (Washington, D.C.: Children's Defense Fund, 1990).

Cardiopulmonary Resuscitation, O.C.G.A. 31-39-2 (1991); Orders Not to Resuscitate, N.Y. C.L.S. Pub. Health 2961 (1991); Scope and Limitations Regarding Life-Sustaining Treatment, N.J. Stat. 26:2H–67 (1992); and Health Care Decisions Act, Va. Code Ann. 54.1–2981 (1992).

Spielman Bethany , “Invoking the Law in Ethics Consultation,” Cambridge Quarterly of Healthcare Ethics, 2 (1993): 457–67.

Health Care Decisions Act, Va. Code Ann. 54.1–2981 (1992) (emphasis added); see also Medical Durable Power of Attorney, C.R.S. 15-14-506 (1993); Declarations Concerning Life-Sustaining Procedures, La. R.S 40:1299.58.1 (1992); and Health Care Decision Act, Md. Health-Gen. Code Ann. 5–6111 (1993).

Orders Not to Resuscitate, N.Y. C.L.S. Pub. Health 2961 (1991).

Cardiopulmonary Resuscitation, O.C.G.A. 31-39-2 (1991) (emphasis added).

Living Wills and Life Prolonging Procedures, Burns Ind. Code Ann. 16-36-4 (1993); Declarations, Life Support, R.S. Mo. 459.010 (1992); and Uniform Rights of the Terminally Ill Act, N.D. Cent. Code 23-06.4-02 (1993).

Durable Power of Attorney for Health Care, O.C.G.A. 31-36-1 (1990) (emphasis added).

Powers of Attorney for Health Care, 755 I.L.C.S. 45/4–10 (1986); Durable Power of Attorney for Health Care, Nev. Rev. St. Ann. 449.830 (1987); and Durable Power of Attorney Sample Form, H.R.S. 551D-2.6 (1988) (emphasis added).

Durable Power of Attorney for Health Care, O.C.G.A. 31-36-1 (1990).

The Fourth Circuit Court of Appeals observed correctly that Virginia's Health Care Decisions Act applies only to adults, not to infants such as Baby K. That fact would have been reason enough for finding Fairfax Hospital's appeal to Virginia's futility clause unpersuasive.

In the Matter of Baby K, supra note 6.

Brody, supra note 32.

Callahan , supra note 13.

Task Force on Ethics of the Society of Critical Care Medicine, supra note 36.

Wayne Hicks L. , “Life or Death: Health Officials are Pioneering Broad Guidelines to Prevent ‘Futile Care’ in Local Hospitals,” The Denver Business Journal, October 8, 1993, sec. 1:1; Hudson Terese , “Are Futile-Care Policies the Answer? Providers Struggle with Decisions for Patients Near the End of Life,” Hospitals & Health Networks, 68 (1994): 26–32; and Gianelli Diane M. , “One Committee Looks for Consensus on ‘Futile Care’,” American Medical News, 36 (Sept. 20, 1993): 10.