Should doctors be able to refuse demands for “futile” treatment? “Futile” treatment is when there is no medical benefit from the treatment they are receiving, and that there will be no improvement if they are in a permanent vegetative state. Although the concept of medical futility dates back in the Ancient Greek days with physician Hippocrates, it has only recently (in the past 40 years) become a controversial topic. The issue of medical futility is important because it deals with many issues such as patient-physician relationship, financial resources, and most importantly it deals with lives of people.
The issues are controversial because it has alarmed many people that physicians may be taking it a step too far being able to pull the plug on a person with an incapacitating condition. The debate is over who has the right to make this decision – the patient’s family or physician. There are two sides to this debate; the “Yes” side says that the physician is more qualified and is following what the patient’s want to receive while the “No” side says that it should not be up to the physician to decide if the life is worth keeping or not.
Steven Miles supports the idea that doctors should be able to refuse futile medical treatment. He maintains that physicians should be able to refuse futile medical treatment because it takes up too many resources, violates community standards, and it follows patient’s wishes when what they expect is not what the treatment can achieve. The example used in the book is the case of Helga Wanglie, an 85 year old woman who was placed on a respirator. She was unconscious and unable to make a decision whether to end her life or not, so it would be either the family’s decision or the physician’s decision.
The cost was a huge factor; Medicare was paying $200,000 to keep Mrs. Wanglie alive while a private insurer was paying $500,000. Steven Miles argues that this money could be better spent on patients that could receive more appropriate treatment. The main problem with costs though is a universal healthcare system, in which people with more social power will get more immediate treatment compared to less socially powerful people. Just because a patient requests a certain treatment, does not mean the patient can receive that treatment.
Patients cannot request a physician to injure them, provide plausible but inappropriate therapies, or therapies that have no value. Physicians also do not have to violate their own moral code as long as the patient’s rights are served. There comes a point when a physician says “Sorry, there is nothing we can do. ” For example, Mrs. Wanglie had aortic insufficiency, but giving her a valve replacement was medically inappropriate because it would benefit her medically. Overall the husband’s request for Mrs. Wanglie seemed entirely inconsistent with what medical care could do for his wife.
Doctors are supposed to tell their patients all forms of treatments (even from other providers) and make sure the treatment is appropriate and beneficial. If it is not, then the physician does not have to supply it. I support Steven Miles’ side. The main goal of a physician is to make sure that their patient benefits from the treatment. Continuing to put someone on a respirator even though he or she is going to die soon is not benefiting the patient. But the most important aspect is the allocation of resources. The respirator for Mrs. Wanglie is practically pointless, but someone who has a chance at life may need it. If Mrs.
Wanglie is taking up precious resources then there is a less likely chance that the person that does have a chance may not get that resource. Another resource that is a major factor is cost. The $500,000 the private insurer spent on Mrs. Wanglie could have also gone to more people who need it. In addition to this, there does come to a point where keeping someone on life support is no longer worthwhile. Because of the scarce resources, there comes a time when there is nothing else a physician can do. Instead of letting the patient live in a vegetable state, the doctor can let the patient die a dignified and peaceful death.
When a patient can no longer may conscious decisions and will die anyway (according to physicians) then they are already practically dead. With your brain gone you have no memory or personality – you are dead and keeping you alive for a few more months is futile. Keeping them alive on futile treatment is only giving the illusion of prolonging the life, but it is only by accepting that death is inevitable and instead of prolonging the life they can instead make the death more comfortable for the patient and make practical decisions to where the place of death will be.
The main problem with my argument is that who is to decide who can live or die? Is this a slippery slope? For all we know, Mrs. Wanglie could have woke up from her coma. Physicians have been wrong before. It could start a slippery slope in that physicians can just decide that you only have 6 months to live and pull the plug without the patient’s or family’s consent. It gives too much power to the physician.
New research has shown that people in a vegetative state have more awareness of their surroundings than thought before. This makes dismissing their care as “futile” a slippery slope that could eventually lead to legalized murder (Dial 1). Someone should be able to receive “futile” treatment as it is more humane, especially if the person is aware of their surroundings and can afford it.
WORKS CITED: Dial, Karla. “Are futility policies good for patients? ” PROCON. ORG. Accessed Feb. July 6, 2011.