Today'sBoston Globe includes an article titledWho Decides when You Die?which roughly describes the futility policies of several Boston hospitals.
About four years ago, Beth Israel Deaconess established a policy for handling cases when doctors and patients - or patients' families - disagree about stopping treatment. The policy sets up a methodical appeal, hearing and review process when a doctor concludes further treatment would be ineffective or harmful, and a patient or family feels otherwise. The process includes review by a committee with a social worker, clergy member, and doctors not involved with the case.
If the committee decides further treatment is ineffective and/or harmful, the patient or family is offered the opportunity to seek transfer to a facility willing to provide that treatment. They also are advised that they can seek legal intervention.
Given how emotionally charged - and intertwined with family dynamics - the decision often is, "sometimes we have to help the patient figure out what the patient really wants," said Dr. Lachlan Forrow, director of Beth Israel's palliative care and ethics programs. Forrow helped write the policy.
Brigham and Women's Hospital says its policies are similar to Beth Israel's. All hospitals, as part of a national accreditation process, are required to have written policies on patient rights, end of life care and staff rights to refuse to participate or give care, according to the Massachusetts Hospital Association. Most often conflicts are addressed by ethics committees.