Advertisement

Are there Limits to Oncology Care? (Futility)

  • Gary R. Shapiro
Part of the Cancer Treatment and Research book series (CTAR, volume 140)

Abstract

Just when it looked like we had finally decided that patients were in charge, doctors and patients are again at odds over just “whose life it is anyway.” Not long ago it was the patients and their families taking the doctors and their hospitals to court for the right to have unwanted life support withdrawn.1 Now it seems that the tables have turned. It is the doctors and their hospitals who are going to court2,3,4,5,6 to “deal... with families who demand inappropriate medical treatment for moribund patients.”7

Keywords

Acceptable Treatment Pneumococcal Pneumonia Medical Futility Adequate Reason Moribund Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    In the Matter of Karen Ann Quinlan, an alleged incompetent. 355A. 2d 647; or 70 NJ 10. March 31, 1976.Google Scholar
  2. 2.
    In Re: The Conservatorship of Helga M. Wanglie, PX-91-283, Fourth Judicial District (District Court Probate Court Div.) Hennepin County, Minnesota.Google Scholar
  3. 3.
    In the Matter of Baby K, 16 F.3d 590 (4th Cir. 1994).Google Scholar
  4. 4.
    Paris JJ, Crone RK, Reardon F. Physicians’ refusal of requested treatment: The case of Baby L. N Engl J Med. 1990;322:1012–1015.PubMedCrossRefGoogle Scholar
  5. 5.
    Kolta G. Court ruling limits rights of patients: care deemed futile may be withheld. New York Times. 1995 April 22; Sect A-6.Google Scholar
  6. 6.
    Roberts D. Wife battles Winnipeg hospital to keep husband alive. Toronto Globe and Mail. 1998 Nov 10; Sect A-3.Google Scholar
  7. 7.
    Crippen D. Dealing with families who demand inappropriate medical treatment for moribund patients. Intensive Care World. 1992;9:78–80.Google Scholar
  8. 8.
    Lo B, Jonsen AR. Ethical decisions in the care of a patient terminally ill with metastatic cancer. Ann IntMed. 1980;92:107–111.Google Scholar
  9. 9.
    Heffner JE, Brow LK, Barbieri CA. Publications in subspecialty journals on end-of-life ethics. Arch IntMed. 1991;157:685–690.CrossRefGoogle Scholar
  10. 10.
    Blackhall LJ. Must we always use CPR? N Engl J Med. 1987;317:1281–1285.PubMedCrossRefGoogle Scholar
  11. 11.
    Tomlinson T, Brody H. Ethics and communication in do-not-resuscitate orders. N Engl J Med. 1988;318:43–46.PubMedCrossRefGoogle Scholar
  12. 12.
    Lantos JD, Singer PA, Walker RM, Gramelspacher GP, Shapiro GR, Sanchez-Gonzalez MA, Stocking CB, Miles SH, Siegler M. The illusion of futility in clinical practice. Am J Med. 1989;87:81–84.PubMedCrossRefGoogle Scholar
  13. 13.
    Shapiro GR. Unpublished Medline keyword search. Oct. 1998.Google Scholar
  14. 14.
    Bailer JC 3rd, Gornik HL. Cancer undefeated. NEnglJMed. 1997;336:1569–1574.CrossRefGoogle Scholar
  15. 15.
    Faber-Lagendoen, K. Resuscitation of patients with metastatic cancer. Arch Int Med. 1991;151:235–239.CrossRefGoogle Scholar
  16. 16.
    Kitzhaber JA. The Oregon health plan: a process for reform. Ann Emergency Med. 1994;23:330–333.CrossRefGoogle Scholar
  17. 17.
    Jeker NS, Schneidermann LJ. When families request that everything possible be done. J Med & Philosophy. 1995;20:145–163.CrossRefGoogle Scholar
  18. 18.
    Escalante CP, Martin CG, Elting LS, et al. Dyspnea in cancer patients: etiology, resource utilization and survival — implications in a managed care world. Cancer. 1996;78:1320–1325.CrossRefGoogle Scholar
  19. 19.
    Rubenfeld GD, Crawford SW. Withdrawing life support from mechanically ventilated recipients of bone marrow transplants: a case for evidence-based guidelines. Ann Int Med. 1996;125:625–633.PubMedGoogle Scholar
  20. 20.
    American Medical Association Council on Ethical and Judicial Affairs. Medical futility in end-of-life care. JAMA. 1999;281:937–941.CrossRefGoogle Scholar
  21. 21.
    American Thoracic Society Bioethics Task Force. Withholding and withdrawing life-sustaining therapy. Am Rev Respir Dis. 1991;144:726–731.CrossRefGoogle Scholar
  22. 22.
    Bedell SE, Delbanco TL, Cook EF, Epstein FH. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med. 1983;309:569–576.PubMedCrossRefGoogle Scholar
  23. 23.
    Schneiderman LJ, Jecker NS, Jonsen AR. Medical futility: its meaning and ethical implications. Ann Intern Med. 1990;112:949–954.PubMedGoogle Scholar
  24. 24.
    Schneiderman LJ, Faber-Langendoen K, Jecker NS. Am J Med. 1994;96:110–114.PubMedCrossRefGoogle Scholar
  25. 25.
    Truog RD, Brett AS, Frader J. The problem with futility. N Engl J Med. 1992;326:1560–1564.PubMedCrossRefGoogle Scholar
  26. 26.
    Vitelli CE, Cooper K, Rogatko A, Brennan MF. Cardiopulmonary resuscitation and the patient with cancer. J Clin Oncol. 1991;9:111–115.PubMedGoogle Scholar
  27. 27.
    Truog RD. Progress in the futility debate. J Clinical Ethics. 1995;6:128–132.Google Scholar
  28. 28.
    Solomon MZ. How physicians talk about futility: making word mean too many things. J of Law Med & Ethics. 1993;21:231–237.CrossRefGoogle Scholar
  29. 29.
    Curtis RJ, Park DR, Krone MR, Pearlman RA. Use of the medical futility rationale in do-not-attempt-resuscitation orders. JAMA. 1995;273:124–128.PubMedCrossRefGoogle Scholar
  30. 30.
    Zawacki BE. The “futility debate” and the management of Gordian knots. J Clinical Ethics. 1995;6:112–127.Google Scholar
  31. 31.
    Katz J. The Silent World of Doctor and Patient. New York: Free Press. 1997.Google Scholar
  32. 32.
    American College of Physicians Ethics Manual. Ann Intern Med. 1998;128:576–594.Google Scholar
  33. 33.
    Caralis PV, Davis B, Wright K, Marcial E. The influence of ethnicity and race on attitudes toward advance directives, life-prolonging treatments, and euthanasia. J Clinical Ethics. 1993;4:155–165.Google Scholar
  34. 34.
    United States Department of Health and Human Services Policy for the Protection of Human Subjects. Fed Register. Vol 46, No 17:8951. January 27, 1981.Google Scholar
  35. 35.
    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Making Health Care Decisions: the Ethical and Legal Implications of Informed Consent in the Patient-Practitioner Relationship. Washington, DC: Government Printing Office. 1982:42-44.Google Scholar
  36. 36.
    Gert B, Culver CM, Clouser KD. Bioethics: a return to fundamentals. New York: Oxford University Press. 1997:93–130.Google Scholar
  37. 37.
    Gert B. Morality: a new justification of the Moral rules. New York: Oxford University Press. 1988.Google Scholar
  38. 38.
    Brett AS, McCulloug LB. When patients request specific interventions: defining the limits of the physician’s obligation. N Engl J Med. 1986;315:1347–1351.PubMedCrossRefGoogle Scholar
  39. 39.
    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Deciding to Forego Life-Sustaining Treatment. Washington, DC: Government Printing Office. 1983.Google Scholar
  40. 40.
    Wanzer SH, Adelstein SJ, Cranford RE, et al. The physician’s responsibility toward hopelessly ill patients. N Engl J Med. 1984;310:955–959.PubMedCrossRefGoogle Scholar
  41. 41.
    Shapiro GR. Not telling Russian immigrants the truth about cancer: cultural sensitivity or misplaced paternalism? Psycho-oncology. 1996;5:196.CrossRefGoogle Scholar
  42. 42.
    Gert B, Culver CM, Clouser KD. 1997:149-180.Google Scholar
  43. 43.
    Brock DW, Wartman SA. When competent patients make irrational choices. N Engl J Med. 1990;322:1595–1599.PubMedCrossRefGoogle Scholar
  44. 44.
    Gert B. 1988:286-295.Google Scholar
  45. 45.
    Gert B, Culver CM, Clouser KD. 1997:26-31.Google Scholar
  46. 46.
    Doukas DJ, McCullough LB. A preventive ethics approach to counseling patients about clinical futility in the primary care setting. Arch Fam Med. 1996;5:589–592.PubMedCrossRefGoogle Scholar
  47. 47.
    Solomon MZ, O’Donnell L, Jennings B, et al. Decisions near the end of life: professional views on life-sustaining treatments. Am J Public Health. 1993;83:14–23.PubMedCrossRefGoogle Scholar
  48. 48.
    Jecker NS, Schneiderman LJ. Futility and rationing. Am J Med. 1992;92:189–196.PubMedCrossRefGoogle Scholar
  49. 49.
    Studnicki J, Schapira DV, Straumfjord JV, et al. A national profile of the use of intensive care by Medicare patients with cancer. Cancer. 1994;74:2366–2373.PubMedCrossRefGoogle Scholar
  50. 50.
    Gatter RA, Moskop JC. From futility to triage. J of Med and Philos. 1995;20:191–205.CrossRefGoogle Scholar
  51. 51.
    DeLima M, Ghaddar H, Pierce S, Estey E. Treatment of newly-diagnosed acute myelogenous leukaemia in patients aged 80 years and above. Br J Haematology. 1996;93:89–95.CrossRefGoogle Scholar
  52. 52.
    Kitagawa T, Hara M, Sano T, Sugimura T. The concept of tenju-gann, or “natural-end cancer.” Cancer. 1998;83:1061–5.PubMedCrossRefGoogle Scholar
  53. 53.
    Callahan D. What Kind of Life: The limits of medical progress. New York: Simon & Schuster. 1990.Google Scholar
  54. 54.
    Slevin ML. Quality of life: philosophical questions or clinical reality? Br Med J. 1992;305:466–469.CrossRefGoogle Scholar
  55. 55.
    O’Connor AMC, Boyd NF, Padraig W, Stolbach L, Till JE. Eliciting preferences for alternative drug therapies in oncology: influence of treatment outcome description, elicitation technique and treatment experience on preferences. J Chron Dis. 1987;40:811–818.PubMedCrossRefGoogle Scholar
  56. 56.
    Tsevat J, Dawson NV, Wu AW, et al. Health values of Hospitalized patients 80 years or older. JAMA. 1998;279:371–375.PubMedCrossRefGoogle Scholar
  57. 57.
    Hamel MB, Teno JM, Goldman L, et al. Patient age and decisions to withhold life-sustaining treatments from seriously ill, hospitalized adults. Ann Intern Med. 1999; 130:116–125.PubMedGoogle Scholar
  58. 58.
    Cassileth BR, Zupkis RV, Sutton-Smith K, March BA. Information and participation preferences among cancer patients. Ann Intern Med. 1980;92:832–836.PubMedGoogle Scholar
  59. 59.
    U.S. Preventive Services Task Force. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions. Baltimore: Williams &Wilkins. 1989.Google Scholar
  60. 60.
    Sharpe VA, Faden AI. Appropriateness in patient care: a new conceptual framework. Milbank Quarterly. 1996,74:115–138.PubMedCrossRefGoogle Scholar
  61. 61.
    Rosenbaum S, Frankford DM, Moor B, Borzi P. Who should determine when health care is medically necessary? N Engl J Med. 1999;340:229–232.PubMedCrossRefGoogle Scholar
  62. 62.
    Guyatt GH, Keller JL, Jaeschke R, et al. The n-of-1 randomized controlled trial: clinical usefulness. Our three-year experience. Ann Intern Med. 1990; 112:293–299.Google Scholar
  63. 63.
    Gregory DR, Cotler MP. Futility: are goals the problem? Part two. Cambridge Quarterly of Healthcare Ethics. 1994;3:125–134.PubMedCrossRefGoogle Scholar
  64. 64.
    Ravdin PM, Siminoff IA, Harvey JA. Survey of breast cancer patients concerning their knowledge and expectations of adjuvant therapy. J Clin Oncol. 1998;16:515–521.PubMedGoogle Scholar
  65. 65.
    Weeks JC, Cook EF, O’Day SJ, et al. Relationship between cancer patients’ predictions of prognosis and their treatment preferences. JAMA. 1998;279:1709–1714.PubMedCrossRefGoogle Scholar
  66. 66.
    Daugherty C, Ratain MJ, Grochowski E, et al. Perceptions of cancer patients and their physicians involved in phase I trials. J Clin Oncol. 1995;13:1062–1072.PubMedGoogle Scholar
  67. 67.
    Slevin ML, Stubbs L, Plant H, et al. Attitudes to chemotherapy: comparing views of patients with those of doctors, nurses, and general public. Br Med J. 1990;300:1458–1460.CrossRefGoogle Scholar
  68. 68.
    Benner SE, Fetting JH, Brenner MH. A stopping rule for standard chemotherapy for metastatic breast cancer: lessons from a survey of Maryland medical oncologists. Cancer Investigation. 1994;12:451–455.PubMedCrossRefGoogle Scholar
  69. 69.
    Prendergast TJ. Futility and the common cold: how requests for antibiotics can illuminate care at the end of life. Chest. 1995;107:836–844.PubMedCrossRefGoogle Scholar
  70. 70.
    Shapiro GR, Stocking CB, LaPuma J, Silverstein MD, Roland D, Siegler M. Do not resuscitate orders & life-sustaining therapy: a comparison of oncologists’ & nononcologists’ attitudes. Proc Am Soc Clin Oncol. 1988;7:269.Google Scholar

Copyright information

© Springer Science+Business Media New York 2000

Authors and Affiliations

  • Gary R. Shapiro

There are no affiliations available

Personalised recommendations