Virtual Mentor. January 2005, Volume 7, Number 1.
Case 5.1: Futile Care—An Inoperable Cancer
In the course of clinical care of a critically ill patient, it may become clear that the patient's condition is terminal and that further intervention will do no more than prolong the dying process. At this point, further intervention is often described as "futile," a term whose meaning depends on a subjective judgment. This judgment arises from considerations about quality of life, which Opinion 2.17, "Quality of Life," clearly leaves to patients: "quality of life, as defined by the patient's interests and values, is a factor to be considered in determining what is best for the individual." Nevertheless, patient decisions about futile or non-futile care do not compel physicians to comply with requests that, in the physician's judgment, meet no treatment or care goals.
For non-terminal situations, Opinion 2.035 defines the limits of physician obligations when patients request an unindicated treatment.
For patients with a terminal prognosis, the AMA recommends defining futility on a case-by-case basis, taking full account of the context and individuals involved. The Code, in Opinion 2.037, "Medical Futility in End-of-Life Care," outlines a due process approach to achieving this case-by-case determination:
This procedural approach (or "due process" as it is referred to above) is preferable because in cases of patient-physician disagreement, it can incorporate institutional and community standards for patient benefit. It also allows a hearing for patient or proxy assessments of worthwhile outcomes, and for physicians' or other professionals' intention in treating the patient. Finally, it has the advantage of providing a system for addressing the ethical dilemmas around end-of-life care without immediate recourse to the court system.
The people and events in this case are fictional. Resemblance to real events or to names of people, living or dead, is entirely coincidental. The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.
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