Reflection Paper On Medical Futility

In his article “Whose Body Is It, Anyway?”—appearing in the New Yorker in October 1994—Dr. Atul Gawande highlights the complexities of the doctor-patient relationship vis-à-vis patient autonomy and decision-making. Dr. Gawande explains that a respect for patient autonomy (i.e., allowing patients to choose between courses of treatment, therefore directly influencing their health outcome) is the “new normal” for medical practitioners. However, Gawande also contends that there are times when patients are better served by a voluntary relinquishment of that autonomy.

The dilemma for ethics committees brought up by the story of Patrick is a question of how much is too much. As technologies in the medical field continue to advance, people can live substantially longer lives, but are they lives worth living? Some people, like Patrick, don’t think being paralyzed is a quality of life worth living. Others, like Armando, refuse to be made DNR and cling to life even if it consists of communicating by blinking of the eye. The questions raised in this book are awful decisions that nobody should ever have to make. Whatever the committees and doctors choose to do can keep patients alive and allow them to have a low quality of live, be in constant pain and be a burden to society, or keep a terminally ill patient comfortable until he or she has said their good-byes and let nature take its course.

Aiding the death of infants is a much disputed controversy in healthcare. H. Tristram Engelhardt Jr. provides an ethical view that there is a moral duty not to treat an impaired infant when this will only prolong a painful life or would only lead to a painful death. It is these individuals, like Engelhardt, who must defend this position against groups who consider that we have the ability to prolong the lives of impaired infants, thus we are obligated to do so.

Very often, deliberate decisions are made which results in the end of a life. For example, a person could be kept on life support, but instead, a family member or other significant person might choose to switch off the life support machine resulting in the official death of a patient. There is also the case that resuscitation of a patient may eventually prove to be trivial and a doctor might suggest just making the patient as comfortable as possible until their eventual passing. In the above situations, a medical professional’s decisions would not be questioned or doubted. It is conventional practice (Warnock and MacDonald 2008).

Throughout history there has been many ethical dilemmas that have resulted in change, and many that have still not been resolve. These dilemmas often result in controversial issues arising, and both sides of the spectrum arguing as to which proposed idea is the morally correct one. Today, there is an enormous controversy in the ethical dilemma involving child care. This issue revolves around whether the views of the parents should be upheld when their child is in danger medically. To further assess the impact of this ethical dilemmas, a case study involving the treatment implemented on a child by a physician while opposing the views and wishes held by the parents will be analyzed in terms of the ethics of the situation, the stakeholders, values,

“One of the obligations for nursing staff and everyone is to take care of the dead body whose perfused organs are being maintained by machines”, a panelist interjected. Many hospitals have policies whereby if one is hired by the hospital and has a personal, moral, or religious objection to certain things, then every effort will be made for someone else to participate – termination of pregnancy serves as an example, he continued. Furthermore, he emphasized that there does not have to be a conscientious objection on the part of the doctors or nurses based on spiritual, philosophical, or religious grounds; it’s solely based on not being required to give treatments that one believes are futile. As another member put it succinctly, “You can recuse yourself from performing such duties”. Moreover, the idea of futility is a vague idea, mentioned a panelist; he stressed that in this particular instance, regarding the woman’s brain-death state, this is totally futile. The whole idea behind a religious exemption is, as he put it: “You are not dead based on spiritual grounds. The family believes that it is not actual death – it is not cardiopulmonary death”. In addition, the doctor emphasized that many health practitioners also hold the same religious ideals and would conclude that the person is not dead.

It is mostly debated that as an expression of autonomy i.e. one’s right to make independent choices without any external influences, a competent adult can refuse medical treatment, even in situations where this could result in his/her death. However, when it comes to actively ending a life via euthanasia it becomes an extensively debate regarding the rights of an individual to make that choice. The article “A Doctor-Assisted Disaster for Medicine” loosely examines the negative implications of assisted suicide laws on patients. Toffler’s article sheds light upon how the law has changed the relationship between patients and their medical provider.

For example, the withdrawal of fluids and nutrition from a dying patient, when does a healthcare professional determine the provision of fluids and nutrition serves no medical purpose in sustaining life and human care (Furlong, B., & Morrison, E. E. 2014, p. 173)? From a clinical standpoint, it is not ethical to withhold life-sustaining treatment, but, is it the “right choice and decision. Does this decision impede on the patient’s bodily integrity, self-determination, and autonomy? From an institutional standpoint, society views healthcare professionals as responsible care givers, and they sustain life, not take away. This is conflicting because does withholding life-sustaining treatment, help or harm the patient? Healthcare professionals are morally obligated to help other, do good, and do no harm. But, in this situation of withdrawing fluids and nutrition from a dying patient, this question is asked “how, clinically, does withdrawing nutrition and hydration benefit a patient and avoids doing harm (Furlong, B., & Morrison, E. E. 2014,

I will argue that it isn’t permissible to withhold information from Merry regarding her medical condition. First, I’ll begin discussing the autonomy and paternalism in the context of the doctor-patient relationship. Second, conceptual issues of ethical dilemma, soft and hard paternalism, and the proposed justification of its implications. Perhaps the strongest argument is how a patient should be treated when they are not acting fully rational.

The law also allows a physician to deny performing the treatment for personal beliefs. Yet, if the harm is done and the patient is incurable, the doctor can save tremendous pain and suffering of patients. With the multitude of obstacle courses the protocol have set in place, have been thought out and designed to protect the rights of not only the patient but

ed. For the immense number of ill patients, the solution to their suffering is predominately quality sedative care, of which I ardently encourage. Though there are ill patients who seek sedative care, there is a significant amount of terminally ill patients for whom palliative care is not the solution and who suffer tremendously until they die. These are the type of patients who wish to end their suffering by making the decision to end their lives with the assistance of doctors. This also allows them to end their lives with dignity, and place of their choice. The only way to prevent suffering of this amount is to revise the law so patients are allowed to lawfully receive assistance to peacefully pass away.

With major advancement in medical treatments, it is now possible to keep a patient alive, which would not have been possible in former times. This has made end of life issue one of the most controversial issues in healthcare. Medical improvements have set the stage for ethical and legal controversies about not only the patient’s rights but also the family’s rights and the medical profession’s proper role. It is critical that any decision made in such situation is ethical and legal to preserve the rights of the patient and also protect the healthcare institution involved. It is very important when making decisions to discontinue treatments to make sure all other alternatives have been explored.

Futility is not a new concept to field of medicine. Hippocrates said that physicians should “refuse to treat those who are overmastered by their disease, realizing that in such cases medicine is powerless”1 .Forgoing (withdrawing or withholding) life sustaining measures, may sound a negative in grammatical form, but it is a compassionate way of maintaining patient’s dignity when these measures of prolonging life seems to just defy death and not providing fruitful outcome, and also in a way, it defines limits to technological advancement of the medical field 2,3.Physicians must realize that, despite huge advances in medical science and technology, not everyone can be saved at all times. Doing everything that is best for the patient may not always include life prolonging measures like CPR or ventilation, but rather may imply moving from curing to caring for a patient with palliative care.

The debate, on whether euthanasia should be carried out on sick patients in hospitals, and wether life supporting equipments should be withdrawn for such patients has continued to elicit debate. There are those who believe that all measures should be taken to ensure patients have been alleviated from pain. Proponents of euthanasia argue that patients in pain should not be left to continue suffering, and that doctors have a role to ensure they do everything possible to terminate the suffering. On a similar platform, proponents of euthanasia also believe that treatment to sustain life can also be withheld or withdrawn if the patient is critically ill. This means that doctors can easily withhold any treatment that could have been used to prolong the life of the patient, if the patient is believed to be critically ill, and that no amount of treatment would alleviate death. However, opponents of euthanasia believe that any action aimed at terminating life is wrong and should not be tolerated. On a similar platform, opponents believe to be a criminal action, any action taken to withhold or withdraw any treatment that has the capability of sustaining life. This essay is going to discuss euthanasia and the withholding or withdrawing of life-sustaining treatment in respect to the stipulations of Australian Law. It will also continue to analyse the differences in their definitions and make assertions on whether the distinctions provided by the Australian Law are

Medical futility is a judgment that further medical treatment of a patient would have no useful result and that medical treatment whose success is possible, although reasoning and experience suggest that it is highly improbable. Deciding to withdraw care on a patient is difficult for all involved, however in some cases it is a necessary, humane, decision. Two very different examples are the case study in our reading, Mr. Smith, and of Terri Schiavo.