Doing All They Can: Physicians Who Deny Medical Futility
Swanson, Jeffrey W.
McCrary, S. Van
Journal of Law, Medicine and Ethics. 1994 Winter; 22(4): 318-326.
Why do some physicians continue to treat patients who are clearly dying or persistently unconscious, while others consider medical intervention to be futile past a certain point? No doubt, medical decisions vary in part because clinical information is often ambiguous in individual cases and because it may support more than one reasonable interpretation of a patient's chances for survival or improvement if a particular treatment is administered. Also, cases vary considerably to the extent that a patient's or a family member's preferences for treatment are communicated, understood, and implemented. But, beyond these contingencies, patients at the end of life may receive more, less, or different treatment because physicians themselves are social actors, individuals who bring to bear on their clinical decisions a variety of personal attitudes, values, concerns, and interests. Legal defensiveness, religious vitalism, authoritarianism, intolerance of ambiguity, and other traits may influence physicians' behavior, but each may be concealed under the rubric of what is "medically indicated" or "medically appropriate." In this paper, we identify several nonmedical characteristics of physicians, which are statistically associated with a posture of denial of medical futility, in a survey of 301 physicians practising at academic medical centers in Texas.
Academic Medical Centers; Allowing to Die; Attitudes; Authoritarianism; Cancer; Decision Making; Futility; Health; Hospitals; Legal Liability; Life; Liability; Patients; Physician Patient Relationship; Physicians; Prolongation of Life; Quality of Life; Religion; Science; Survey; Terminally Ill; Values;
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McCrary, S. Van; Swanson, Jeffrey W.; Youngner, Stuart J.; Perkins, Henry S.; Winslade, William J. (1994)We believe that data indicating the level of agreement among physicians on the issue of futility will advance the debate regarding the appropriateness of physicians' acting as unilateral arbiters of futility. Therefore, ...