Response to Dobken's "About Medical Futility and Healthcare Reform Ethics"
Posted Feb 16 2010 4:34pm
Jeffrey Hall Dobken has a 2-page column in yesterday's Medpagetoday titled "About Medical Futility and Healthcare Reform Ethics."
A significant bulk of the article literally raises many, many questions. And this is a fine mission for an article, to prompt the reader into reflection. A particularly good question is "How can a pluralistic society develop coherent policies on such matters while respecting the plausible, yet conflicting and rationally irreconcilable, viewpoints of many of its members?"
To the extent that the article stakes out some normative claims, one might be "Legislative action that requires or expects abandonment should be opposed by all physicians." I disagree with this claim. Stopping LSMT is not tantamount to abandonment because care will continue. The physician-patient relationship will continue. A second normative claim is that these sorts of treatment decisions must remain "medical and personal" and not become "societal decisions." Not sure that I agree with this either because the decision to defer (or not defer) to surrogate demands is itself a societal decision.
Finally, Dr. Dobken claims that "the only applicable rule . . is that if treatment is futile, in that it will offer no potential benefit to the patient and will only impose pain and suffering, that fact must be made clear when presenting options to the patient or family, stressing that whatever the decision, compassionate care to ease pain and suffering always continues."
This language ("whatever the decision" . . . "options") strongly implies that Dr. Dobken thinks that, if requested by the surrogate, providers should give treatment that offers no potential benefit to the patient and will only impose pain and suffering. But if treatment were really "futile" in this way, then (at least on a best interests standard like in Dr. Dobken's newborn case) the surrogates have neither the legal nor ethical authority to demand it for the patient. This is a societal decision that we have made - through our elected representatives.