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At least 19 recordsLinked to original sources
PubMed1991

Legal procedures in Wanglie: a two-step, not a sidestep.

Hospital policies...have a very limited role in addressing the substantive issue of authority with regard to nonbeneficial therapies. First, they could not be limited, as Mishkin suggests, to persons in a persistent vegetative state. Nonbeneficial therapies encompass many other scenarios including ineffective cancer chemotherapy or open-heart surgery on profoundly demented persons. Second, I am not convinced that families or patients could be meaningfully informed of the specific relevance of such policies to their care in advance of a dispute. Most importantly, the view that such policies are required as a foundation to withhold nonbeneficial therapy implies that patients otherwise have a new right to command the provision of nonbeneficial therapies.... It may well be judicially preferable to ask directly for declarative relief from a duty to provide a treatment, as Mishkin suggests. I am not convinced that such an approach would be "ethically" superior....Third, the novel, declarative approach directly risks a precedent that would affirm the family's right to demand futile therapy....Ultimately, when public policy on this kind of dispute is clearer, a declarative strategy may well be preferable. For now, the Wanglie case has outlined the fundamental issues of this novel legal question and has generated a fruitful discussion of a complex issue in patient care and public policy.

Decision Making↗
PubMed1991

Autonomy's responsibility. A gloss on the Wanglie affair.

In 1990, 87-year-old Helga Wanglie suffered cardiac arrest while being treated for lung disease at a chronic care facility. When she failed to regain consciousness after being resuscitated, a physician suggested the possibility of discontinuing treatment. At this point, her family requested that she be transferred to a hospital for evaluation. After a variety of procedures failed to improve her condition, the attending physician told the family he was no longer willing to prescribe the respirator because it could not serve her personal medical interests and that her unconscious state precluded the possibility of her appreciating life. However, the family insisted that the hospital provide Ms. Wanglie care, and she remained in treatment until she died 13 months later. The dispute between the hospital and the Wanglie family brings into focus the fundamental premises of the doctor-patient-family relationship. The rules for these relationships-described by such terms as "rights," "responsibilities," and "informed consent"--have both private and public dimensions. Mr. Wanglie had a clear right to be fully informed of all medically reasonable treatments and a right to choose or refuse any therapy the physician prescribed. He did not, however, have a right to demand any treatment he wanted.

Aged↗
PubMed1992

Interpersonal issues in the Wanglie case.

The case of Helga Wanglie involved a conflict between the medical team, which concluded that a respirator was providing no medical benefit to the 87-year-old woman and should therefore be discontinued, and Ms. Wanglie's family who did not want the respirator removed. Most published commentary on the case has analyzed the medical team's conclusion. In contrast, this article examines the impact of the conflict on the conduct of the clinical case, and on the relationships among the various parties involved.

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PubMed1995

When families request that 'everything possible' be done.

The paper explores the ethical and psychological issues that arise when family members request that "everything possible" be done for a particular patient. The paper first illustrates this phenomenon by reviewing the well known case of Helga Wanglie. We proceed to argue that in Wanglie and similar cases family members may request futile treatments as a means of conveying that (1) the loss of the patient is tantamount to losing a part of themselves; (2) the patient should not be abandoned or disvalued in any way; or (3) the patient is owed special obligations by virtue of the special relationship in which the family and the patient stand. We maintain that families can best express these important messages by caring for patients, rather than by making requests for futile interventions. Likewise, when life-sustaining measures are futile, health providers can best fulfill their professional obligations by assuring patients' dignity and comfort, rather than by applying futile interventions.

Aged↗