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Is the Treatment Beneficial, Experimental, or Futile?

Published online by Cambridge University Press:  29 July 2009

Lawrence J. Schneiderman
Affiliation:
A professor in the Departments of Family and Preventive Medicine and Medicine, School of Medicine, University of California, San Diego.
Nancy S. Jecker
Affiliation:
The book review editor for CQ, associate professor in the Department of Medical History and Ethics, Department of Philosophy, and School of Law at the University of Washington, Seattle.

Extract

D.T. a 35-year-old woman, was found to have breast cancer. At the time of mastectomy axillary lymph nodes were positive and the cancer was classified as adenocarcinoma, grade 4. The patient underwent conventional chemotherapy. When it became apparent the disease was metastatic, the patient's oncologist contacted a well-known cancer center regarding the possibility of treating the patient with high dose chemotherapy and autologous bone marrow transplantation (HDC/ABMT). The patient's health insurance provider informed the patient, however, that the treatment—estimated to cost in the range of $150,000–200,000—was “considered experimental or research in nature” and therefore was not included in coverage. D.T. did not pursue this further. Approximately 2 years later, cancer was detected in the patient's spine. This time she applied to another well-known cancer center for HDC/ABMT. The cancer center agreed to accept her on the condition of proof of ability to pay for the treatment. Again her insurer refused coverage on the same grounds as before. D.T. found another source for the money, underwent treatment, then sued the insurance carrier. She sought a declaratory judgment that the treatment was covered under the insurance policy. The court ruled in favor of D.T. finding the contract phrase “considered experimental” ambiguous.

Type
Articles
Copyright
Copyright © Cambridge University Press 1996

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References

Notes

1. Grimes, DA. Technology follies: the uncritical acceptance of medical innovation. Journal of the American Medical Association 1993;269:3030–3.CrossRefGoogle ScholarPubMed

2. Taylor v. Blue Cross/Blue Shield of Michigan. 205 Mich. App 644; 517 N.W. 2d 804; 1994 Mich. App. 291; 18 E.B.C. 1711.

3. Eddy, DM. High-dose chemotherapy with autologous bone marrow transplantation for the treatment of metastatic breast cancer. Journal of Clinical Oncology 1992;10(4):657–70.CrossRefGoogle ScholarPubMed

4. Meyer, H. Breast study woes preview reform barriers. American Medical News 1993;03 8:1,8.Google Scholar

5. Schoenbaum, SC. Towards fewer procedures and better outcomes. Journal of the American Medical Association 1993;269:794–6.CrossRefGoogle Scholar

6. Cohen, J. Somber news from the AIDS front. Science 1993;260:1712–3.CrossRefGoogle ScholarPubMed

7. LJ, Schneiderman, Jecker, NS, Jonsen, AR. Medical futility: its meaning and ethical implications. Annals of Internal Medicine 1990;1112:949–54.Google Scholar

8. Schneiderman, LJ, Jecker, NS. Futility in practice. Archives of Internal Medicine 1993;153:437–41.CrossRefGoogle ScholarPubMed

9. LJ, Schneiderman, Faber-Langendoen, K, Jecker, NS. Beyond futility to an ethic of care. American Journal of Medicine 1994;96:110–4.Google Scholar

10. Schneiderman, LJ, Jecker, NS. Wrong Medicine: Doctors, Patients and Futile Treatment. Baltimore, Maryland: Johns Hopkins University Press, 1995.Google Scholar

11. Chalmers, TC. Ethical aspects of clinical trails. American Journal of Ophthalmology 1975;79:753–8.CrossRefGoogle Scholar

12. Altman, LK. Drug mixture curbs HIV in lab, doctor's report, but urge caution. The New York Times 1993;02 18:A1 (col 1).Google Scholar

13. Altman, LK. Fatal drug trial raises questions about “informed consent” New York Times 1993;10 5:col B7.Google Scholar

14. NS, Jecker, Schneiderman, LJ. Medical futility: the duty not to treat. Cambridge Quarterly of Healthcare Ethics 1993;2:151–9.Google Scholar

15. Faber-Langendoen, K. Resuscitation of patients with metastatic cancer: is transient benefit still futile? Archives of Internal Medicine 1991;151:235–9.CrossRefGoogle ScholarPubMed

16. CE, Vitelli, Cooper, K, Rogatko, A, Brennan, MF. Cardiopulmonary resuscitation and the patient with cancer. Journal of Clinical Oncology 1991;9(1):111–5.Google Scholar

17. Phelps, CE. The methodologic foundations of studies of the appropriateness of medical care. New England Journal of Medicine 1993;329:1241–5.CrossRefGoogle ScholarPubMed

18. The University Group Diabetes Program: a study of the effects of hypoglycemic agents on vascular complications in patients with adult-onset diabetes. Diabetes 1970;19(Suppl 2):747.Google Scholar

19. PH, Wang, Lau, J, Chalmers, TC. Meta-analysis of effects of intensive blood-glucose control on late complications of type I diabetes. Lancet 1993;341:1306–9.Google Scholar

20. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term Complications in insulin-dependent diabetes mellitus. New England Journal of Medicine 1993;329:977–86.CrossRefGoogle Scholar

21. McCormick, B. Study: defensive medicine costs nearly $10,000,000,000. American Medical News 1993;02 15:4.Google Scholar

22. Committee to Study Medical Professional Liability and the Delivery of Obstetrical Care, Division of Health Promotion and Disease Prevention, Institute of Medicine. Medical Professional Liability and the Delivery of Obstetrical Care 1989;1:81.Google Scholar

23. Huber, PW. Galileo's Revenge: Junk Science in the Courtroom. New York: Basic Books, 1991:87.Google Scholar

24. Ferguson, JH, Dubinsky, M, Kirsch, PJ. Court-ordered reimbursement for unproven medical technology. Journal of the American Medical Association 1993;269:2116–21.CrossRefGoogle ScholarPubMed

25. Daubert v. Merrell Dow Pharmaceuticals. 951 F2d 1106 (5th Cir 1991), cert granted, 113 SCt 320 (1992), U.S. Supreme Court No. 92–102.

26. NS, Jecker, Schneiderman, LJ. Futility and rationing. American Journal of Medicine 1992;92:189–96.Google Scholar

27. Eckholm, E. Those who pay health costs think about drawing lines. The New York Times 1993;03 28:Sect 4 (col 1):1.Google Scholar