In the current issue of theAmerican Journal of Critical Care, Lisa Day, ssistant Clinical Professor, Department of Physiological Nursing, University of California–San Francisco, has a short article titled "Medical Futility, Personal Goods, and Social Responsibility." She makes some of the standard points, though in a rhetorically novel and revealing way -- for example, by observing that seemingly contrary choices on an advance directive converge because they are both anchored and bounded by notions of "generally accepted healthcare standards."
Day's title suggested that she would discuss the relevance of how "providing the treatments one patient demands burden or benefit others in the community." But this section was really short. Day states that there is a "tension" between a provider's "commitment to the individual patient" and "their desire to be good stewards of community resources."
Most seriously, Day argues that where providers and surrogates cannot resolve a disagreement about what "counts as a beneficial treatment," they should "discontinue the relationship." Yes, sure they should. But this is often not possible because there is no other available willing provider.