Abstract
Futility is not a purely medical concept. Its subjective nature requires a balanced procedural approach where competing views can be aired and in which disputes can be resolved with procedural fairness. Law should play an important role in this process. Pure medical models of futility are based on a false claim of medical sovereignty. Procedural approaches avoid the problems of such claims. This paper examines the arguments for and against the adoption of a procedural approach to futility determination.
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Beauchamp, T.L., and J.F. Childress. 2009. Principles of biomedical ethics, 5th ed. New York: Oxford University Press.
Burns, J.P., and R.D. Truog. 2007. Futility: a concept in evolution. Chest 132(6): 1987–1993.
Callahan, D. 1991. Medical futility, medical necessity: the problem without a name. Hastings Cent Rep 21(4): 30–35.
Dzielak, R.J. 1995. Physicians lose the tug of war to pull the plug: the debate about continued futile medical care. J Marshall L Rev 28: 733–767.
Faunce, T.A., and C. Stewart. 2005. The Messiha and Schiavo cases: third-party ethical and legal interventions in futile care disputes. Med J Aust 183(5): 261–263.
Fine, R.L. 2009. Point: the Texas Advance Directives Act effectively and ethically resolves disputes about medical futility. Chest 136(4): 968–971.
Gabbay, E., J. Calvo-Broce, K.B. Meyer, et al. 2010. The empirical basis for determinations of medial futility. J Gen Intern Med 25: 1083–1089.
Kerridge, I., K. Mitchell, and J. McPhee. 1997. Defining medical futility in ethics, law and clinical practice: an exercise in futility? J Law Med 4(3): 235–242.
Kerridge, I., M. Lowe, and C. Stewart. 2009. Ethics and law for the health professions. Sydney: Federation.
Kuhse, H. 1997. Caring: nurses, women and ethics. Oxford: Blackwell.
Levine, E.M. 1994. A new predicament for physicians: the concept of medical futility, the physician’s obligation to render appropriate treatment, and the interplay of the medical standard of care. J Law Health 9(1): 69–108.
Luce, J.M. 2010. A history of resolving conflicts over end-of-life care in intensive care units in the United States. Crit Care Med 38(8): 1623–1629.
Medical Professionalism Project. 2002. Medical professionalism in the new millennium: a physician’s charter. Med J Aust 177(5): 263–265.
Meisel, A., and K.L. Cerminara. 2004. The right to die: the law of end-of-life decision-making. New York: Aspen.
Moratti, S. 2009. The development of “medical futility”: towards a procedural approach based on the role of the medical profession. J Med Ethics 35: 369–372.
Murphy, B.F. 2008. What has happened to clinical leadership in futile care discussions? Med J Aust 188(7): 418–419.
O’Callaghan, N. 2008. When Atlas shrugs: may the State wash its hands of those in need of life-sustaining medical treatment? Health Matrix 18(2): 291–372.
Parker, M. 2010. Futile choices: wooing doctors to acknowledge the law in Queensland. J Law Med 18(1): 32–37.
Pope, T.M. 2007. Medical futility statutes: no safe harbor to unilaterally refuse life-sustaining treatment. Tenn Law Rev 75(1): 1–81.
Pope, T.M. 2010. Surrogate selection: an increasingly viable, but limited, solution to intractable futility disputes. St. Louis U J Health L Pol’y 3(2): 183–252.
Pope, T.M., and E.A. Waldman. 2007. Mediation at the end of life: getting beyond the limits of the talking cure. Ohio State J Dispute Resolut 23(1): 143–194.
Schmitt, C. 2005. Political theology: four chapters on the concept of sovereignty. Trans. G. Schwab. Chicago: The University of Chicago Press.
Schneiderman, L.J., N.S. Jecker, and A.R. Jonsen. 1990. Medical futility: its meaning and ethical implications. Ann Intern Med 112(12): 949–954.
Skene, L. 2005. The Schiavo and Korp cases: conceptualising end-of-life decision-making. J Law Med 13(2): 223–229.
Smith, G.P. 2005. The Christian religion and biotechnology: a search for principled decision-making. Dordrecht: Springer.
Smith, M.L. 2008. Medical inappropriateness review: appropriately performed by a medical committee. Health Matrix 18: 237–244.
Stewart, C. 2006. Problems with substitute decision-making in NSW. J Bioeth Inq 3(3): 127–131.
Stewart, C. 2009. End-of-life decisions in NSW: the saga continues. J Bioeth Inq 6(2): 153–158.
Truog, R.D. 2007. Tackling medical futility in Texas. N Engl J Med 357: 1–3.
Truog, R.D. 2009. Counterpoint: the Texas advance directives act is ethically flawed—medical futility disputes must be resolved by a fair process. Chest 136(4): 968–971.
Wilkinson, D. 2009. The self-fulfilling prophesy in intensive care. Theor Med Bioeth 30(6): 401–410.
Wilkinson, D., and J. Savulescu. 2011. Knowing when to stop: futility in the ICU. Curr Opin Anaesth:. doi:10.1097/ACO.0b013e328343c5af.
Willmott, L., B. White, and S. Then. 2010. Withholding and withdrawing life-sustaining medical treatment. In Health law in Australia, ed. B. White, F. McDonald, and L. Willmott, 450–491. Sydney: Thomson Reuters.
Wyatt, A. 1998. Toward professionalism: an analysis of ambulance practice. Australas J Emerg Care 5(1): 16–20.
Younger, S.J. 1988. Who defines futility? J Am Med Assoc 260(14): 2094–2095.
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Stewart, C. Futility Determination as a Process: Problems with Medical Sovereignty, Legal Issues and the Strengths and Weakness of the Procedural Approach. Bioethical Inquiry 8, 155–163 (2011). https://doi.org/10.1007/s11673-011-9297-z
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DOI: https://doi.org/10.1007/s11673-011-9297-z