Law, medicine & health care : a publication of the American Society of Law & Medicine
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Law Med Health Care · Jan 1992
Treatment decisions for terminally ill patients: physicians' legal defensiveness and knowledge of medical law.
In this study, we investigated physicians' attitudes, knowledge, and reported practices regarding the effects of perceived legal constraints on the abatement of life-sustaining treatment from patients who are clearly dying. A factor in assessing these issues is the concept of defensive medicine -- that is the perception that doctors are being forced to order every possible laboratory test and second opinion, or to continue providing non-beneficial life-sustaining treatment, solely to protect themselves from future legal claims. This perception appears widespread among practicing physicians. ⋯ This phenomenon encompasses medical, legal, social, psychological, and spiritual factors interacting in ways that are not fully understood. We remain cognizant of the potential impact of all these factors. For purposes of this article, however, we have chosen to focus on legal and psychological aspects of physicians' reluctance to abate treatment and the corresponding ethical implications.
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"Medical futility" may be provisionally defined as a medical conclusion that a therapy is of no value to a patient and should not be prescribed. The current debate about medical futility is one of the most important and contentious in medical ethics. Proponents believe that allowing physicians to determine and withhold futile therapies can be done without disturbing the current paradigm of medical ethics which respects patient autonomy with regard to informed consent and the right to refuse treatment. ⋯ It has two aspects. A definitional debate examines the concept of medical futility and its derived clinical criteria. A second debate considers the nature of the authority and procedures to act on the conclusion that a therapy is futile by withholding or withdrawing treatment.
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Law Med Health Care · Jan 1992
Physicians and futile care: using ethics committees to slow the momentum.
Given the history of the medical profession's diffident attitude toward patients' rights and its reliance on well-meaning paternalism, the notion that doctors should determine futility and limit access to specific interventions must be carefully scrutinized. Indeed, the emergence of two other themes in health policy and ethics, in particular the living will/power of attorney initative on the one hand and the open discussion of rationing care in Oregon on the other, tends to undermine the key rationales for physician control over futile care. Careful review of all three trends suggests that we ought to brake the momentum in favor of physician determination of futility of care and that ethics committees can be the vehicle to address this goal.