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In re Baby K.

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Anencephaly↗

In re Baby K.

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Anencephaly↗

In re Baby K.

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Anencephaly↗

Distanced perspectives: AIDS, anencephaly, and AHP.

US court decisions guaranteeing life-sustaining care to anencephalic infants have been viewed with disfavor, and sometimes disbelief, by some ethicists who do not believe in the necessity of life-sustaining support for those without cognitive abilities or an independently sustainable future. The distance between these two views--one legal and inclusive, the other medical and specific--seems unbridgeable. This paper reports on a program using multicriterion decision making to define and describe persons in a way which both acknowledges the differences perceived by many as well as those commonalities insisted on in U.S. court decisions. It does this through application of the Analytic Hierarchy Process to a hierarchy of "humanness" criteria, and secondarily through reference to that concept's subset, personhood.

Acquired Immunodeficiency Syndrome↗

Physicians do not have a responsibility to provide futile or unreasonable care if a patient or family insists.

OBJECTIVE: This article was written to argue that physicians are not ethically obligated to provide care which they consider futile, unreasonable, or both, either voluntarily or in response to patient or surrogate demands. DATA SOURCES: Data used to prepare this article were drawn from published articles, including original investigations, position papers and editorials in the author's personal files. STUDY SELECTION: Articles were selected for their relevance to the subjects of medical ethics, the concepts of futility and medical reasonableness, case law, and healthcare reform. DATA EXTRACTION: The author extracted all applicable data. DATA SYNTHESIS: Physicians may feel obligated to provide care in all clinical circumstances due to the single master view of medicine and the ethical principle of autonomy. However, care may be considered futile according to several definitions of that word, including that which describes futile treatment as something that does not benefit the patient as a whole. Furthermore, care may be considered unreasonable if it is excessive and not generally agreed upon. Physician refusal to provide futile or unreasonable care is supported by the ethical principles of nonmaleficence, beneficence, and distributive justice. The last principle is particularly relevant in the current climate of healthcare reform. CONCLUSIONS: Although the issue of physician refusal of requested care has not been resolved by case law or legal statute, it is supported by compelling ethical principles. Physicians are not ethically required to provide futile or unreasonable care, especially to patients who are brain dead, vegetative, critically or terminally ill with little chance of recovery, and unlikely to benefit from cardiopulmonary resuscitation.

Adult↗

Can healthcare providers obtain judicial intervention against surrogates who demand "medically inappropriate" life support for incompetent patients?

OBJECTIVE: This article analyzes, from a legal perspective, a recent phenomenon involving a clash between the values of attending medical personnel and the instructions of surrogate decision-makers acting on behalf of incompetent patients. Some hospitals have gone to court to challenge decisions by surrogates to continue life support for permanently unconscious or other gravely debilitated patients. Their claim has been that continuation of life support would be medically inappropriate and that the surrogates' decisions ought to be overridden. These petitions have thus far been rejected. The objective here is to explain those decisions and to predict the outcome of future, similar litigation. DATA SOURCES: The primary data are the judicial decisions and legislation accumulated since the Quinlan case in 1976, regarding the medical handling of dying medical patients. CONCLUSIONS: Judicial rejection of healthcare providers' claims in the decided cases is explainable under traditional guardianship principles. The explanation lies in surrogates' authority to make decisions in the best interests of incompetent patients, and in judicial reluctance to brand life preservation of nonsuffering patients as abusive or contrary to patient interests. At the same time, the author anticipates a change in judicial posture, as courts acknowledge the widespread antipathy of people toward being indefinitely preserved in a noncognitive status. Because the judicial approach to the handling of dying persons often seeks to replicate what the patient would have wanted, there is room to consider consensus preferences where the particular patients has never indicated any deviation from those preferences. Courts will eventually override surrogate decisions that do not conform to widely shared preferences for avoiding the indignity of permanent unconsciousness or other gravely debilitated states.

Coma↗