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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:// /~ 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

  • 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

  • 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

  • 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