Situations in which the patient’s family seems not to be acting in good faith or the patient's suffering is uncontrollable are relatively rare and do not warrant giving physicians unilateral power to withhold or withdraw treatment in all cases of perceived medical futility.
When a seriously ill mature minor and his parent disagree about his receiving an experimental intervention, who should decide what treatment he will receive?
Jalayne J. Arias, JD, MA and Kathryn L. Weise, MD, MA
Even when external factors such as nonaccidental injury weigh heavily on clinicians' perceptions, they should not lose focus on the patient's best interest when deciding whether to continue or withdraw treatment.
Jessie Kimbrough-Sugick, MD, MPH, Jessica Holzer, MA, and Eric B. Bass, MD, MPH
Researchers who approach community partners with an agenda already in hand are missing the point of the community-based participatory research enterprise: developing priorities for study together.
By privileging traditional research methods in forms for research protocol approval, IRBs can unknowingly allow community partners to be harmed in CBPR. Changes to the language can help ensure appropriate sensitivity and community involvement.
Forcing parents to participate in treatment is unlikely to succeed. Seeking to optimize the therapeutic alliance between family and pediatrician is more likely to achieve the desired outcome—the child’s short- and long-term well-being.
CBP researchers are challenged to think strategically about ways to convey their accomplishments and educate their non-CBPR peers about the nature of their research, processes not required of traditional researchers.
Patients who use drugs intravenously may be at high risk for relapse, but their situation is no more futile than that of persons with diabetes and coronary artery disease who smoke and frequent all-you-can-eat buffets.
Elizabeth Lee Daugherty, MD, MPH and Douglas B. White, MD, MA
Opportunities to advance scientific knowledge may arise during humanitarian crises, but their presence does not justify suspension of the ethical foundations governing human subjects research.