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Medical Ethics. Fall 2011 Philosophy 2440 Prof. Robert N. Johnson Friday, August 8, 2014. MIDTERM NEXT THURSDAY (11/13) IN YOUR DISCUSSION LAB DESCRIPTION AND ESSAY QUESTIONS: http:// web.missouri.edu /~ johnsonrn /midtermFS11.htm. Advanced Directives. HELGA WANGLIE.

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Medical ethics
Medical Ethics

Fall 2011

Philosophy 2440

Prof. Robert N. Johnson

Friday, August 8, 2014




Helga wanglie
HELGA WANGLIE

  • Advance directives are normally attempts to limit, withdraw, or withholdtreatment.

  • Wanglie (86 yrs) became dependent on a ventilator, then suffered cardiac arrest and severe brain damage while hospitalized. Physicians: not in her best interest to be kept alive.

  • Family insisted she be kept alive, based on verbal directives.

  • A judge agreed with the family.

  • $800,000 for 2 yrs., Medicare + insurer

    • Should physicians be required to provide treatment which is futile, or no medical benefit?


Grounds for advance directives
Grounds for Advance Directives

  • Right to refuse treatment

  • Honors individual autonomy

  • Promotes individual decision making

  • Reduces family conflict


The push for advance directives
The Push for Advance Directives

Fear of final days of life

  • with a loss of dignity and bound to medical technology

  • spent in unrelieved pain and discomfort

  • reducing personal and family resources


Problems with advance directives
Problems with Advance Directives

Difficulties in determining:

  • Incompetence

  • A "reasonable time" for determining terminal condition

  • A "terminal condition

  • “Irreversible” condition

    Generally, vague and imprecise language


Problems with advance directives1
Problems with Advance Directives

  • Restricts physicians' clinical judgment

  • Support study (“Reconceptualizing Advance Care Planning From the Patient's Perspective”, JAMA, 1998) shows that advance directives are often ignored

    The bottom line: advance directives are attempts to limit treatment, however imprecise they may be.

    Err on the side of doing less rather than doing more


Senses of futile medical treatment
SENSES OF “FUTILE” MEDICAL TREATMENT

  • Of no benefit to the patient, i.e. it is not likely to improve the patient's condition.

  • The quality of outcome of the treatment is extremely poor

  • It will not be felt, recognized, or known by the patient

  • Puts an undesirable burden on the patient (e.g. continues suffering)

  • Is inhumane, undignified; continues an existence that is not meaningful


Futile medical treatment
FUTILE MEDICAL TREATMENT

  • Can a treatment be futile (in whatever sense) for the patient but beneficial for others, e.g. family, friends, caregivers?

  • Can a treatment be futile because it costs too much? Is futility appropriately measured, not just in medical benefits, but in costs/benefits?

  • The assumption: Physicians need not provide, and patients should not ask for, futile treatment


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