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Analysis of Power in Medical Decision-Making: An Argument for Physician Autonomy

Published online by Cambridge University Press:  29 April 2021

Extract

Two of the patient's rights in a Uniform Act for the Terminally Ill should he a) the right to be treated if there is reasonable doubt of the patient's wishes until it becomes clear that the treatment is not beneficial and that the patient is indeed terminally ill, and b) the right not to he subjected to treatment with no medical benefit. A physician with appropriate supporting independent opinions would he the logical individual to whom the responsibility of protecting those rights should be given. This is particularly true when the patient is incapable of his or her own medical decisions and has left no instructions regarding his or her personal goals in medical care in the event of severe illness. Two cases and an analysis of power in medical decision-making illustrate these points.

Type
Article
Copyright
Copyright © American Society of Law, Medicine and Ethics 1992

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References

Kutner, J.S., Ruark, J.E., Raffin, T.A., “Defining Patient Competence for Medical Decision Making,” Chest 1991;100:1404–9.CrossRefGoogle Scholar
President's Commission for the Study of Ethical Problems in Medical and Behavioral Research, Deciding to Forego Life-Sustaining Treatment: A Report on the Ethical, Medical and Legal Issues in Treatment Decisions, Washington D.C., U.S. Government Printing Office 1983.Google Scholar
Truog, R.D., Brett, A.S., Frader, J., “The Problem of Futility,” N Engl J Med 1992;326:15601564; Lantos, J.D., Singer, P.A., Walker, R.M. et al., “The Illusion of Futility in Clinical Practice,” Am J Med 1989;87:81–4; Youngner, S., “Who Defines Futility?” JAMA 1988;260:2094–5; Tomlinson, T., Brody, H., “Futility and the Ethics of Resuscitation,” JAMA 1990;164:1276–1280.Google Scholar
Hoffman, D.E., “Does Legislating Hospital Ethics Committees Make a Difference: A Study of Hospital Ethics Committees in Maryland, The District of Columbia, and Virginia,” Law Medicine & Health Care 1991;19:105–19.CrossRefGoogle Scholar
West, M.B., Gibson, J.M., “Facilitating Medical Ethics Case Review: What Ethics Committees Can Learn From Mediation and Facilitation Techniques,” Cambridge Quarterly of Health Care Ethics (1991);1:6374.Google Scholar
Mayer, B., “Practical Strategies for the Phases of Mediation,” Special Volume of Mediation Quarterly ed Moore, CW. Publishers Jossey-Bass. Summer 1987, pp 7585.Google Scholar
Osmond, H., “God and the Doctor,” N Engl J Med 1980;302:555558.CrossRefGoogle Scholar
Areen, J., “The Legal Status of Consent Obtained from Families of Adult Patients to Withold or Withdraw Treatment,” JAMA 1987;258(2):229235.CrossRefGoogle Scholar
Lynn, J., “Why I Don't Have a Living Will,” Law Medicine & Health Care 1991;19:101104; An ACCP/SCCM Consensus Panel R.C. Bone, Chairmen Rackow, E.C., Weg, J.C., “Ethical and Moral Guidelines for the Initiation, Continuation and Withdrawal of Intensive Care,” Chest 1990;97:949–58; Task Force on Ethics of the Society of Critical Care Medicine, “Consensus Report on the Ethics of Foregoing Life-Sustaining Treatments in the Critically Ill,” Crit Care Med 1990;18:1435–1439; King, P.A., “The Authority of Families to Make Medical Decisions for Incompetent Patients after the Cruzan Decision,” Law Medicine & Health Care 1991;19:76–9; Lo, B., Rouse, F., Dornbrand, L., “Family Decision Making on Trial: Who Decides for Incompetent Patients?” N Eng J Med 1990;322:1228–32; Wolf, S., “Near Death in the Moment of Decision,” N Eng J Med 1990;322: 208–210.Google Scholar
Miles, S.H., “Informed Demand for “Non-Beneficial” Medical Treatment,” N Eng J Med 1991;325:512–5; Cruzan v. Missouri Department of Health 497 U.S.-, III L. ed. 2d 224, 110 S. Ct. 1841 (1990); Oventlicher, D., “The Right to Die after Cruzan,” JAMA 1930;264:2444–6; Weir, R.F., Gostin, L., “Decisions to Abate Life-Sustaining Treatment for Non-Autonomous Patients: Ethical Standards and Legal Liability for Physicians after Cruzan,” JAMA 1990;264:1846–53; Lo, B., Steinbrook, R., “Beyond the Cruzan Case: The U.S. Supreme Court and Medical Practice,” Ann Intern Med 1991;114:895–901; In re Helga Wanglie, Fourth Judicial District (Dist. Ct., Probate CT., Div.) PX-91-283. Minnesota, Hennepin County (1991); Rouse, F., “The Role of State Legislature after Cruzan: What Can—and Should—State Legislatures Do? Law Medicine & Health Care 1991;19:83–90; Pawlson, L.G., “Impact of the Cruzan Case on Medical Practice,” Law Medicine & Health Care 1991;19:69–72; Sprung, C.L., “The Cruzan Decision and Critical Care Physicians,” Crit Care Med 1991;19:598–99.Google Scholar
Seckler, A.B., Meier, D.E., Mulvihill, M., Paris, B.E.C., “Substituted Judgment: How Accurate Are Proxy Predictions?” Ann Intern Med 1991;115:92–8; Tomlinson, T., Howe, K., Notman, M., Rossmiller, D., “An Empirical Study of Proxy Consent for Elderly Persons,” Gerontologist 1990;30:54–64; Zwiebel, N.R., Cassel, C.K., “Treatment Choices at the End of Life: A Comparison of Decisions by Older Patients and Their Physician-Selected Proxies,” Gerontologist 1989;29:615:21; Ouslander, J.G., Tymchuk, A.J., Rahbar, B., “Health Care Decisions among Elderly Long-Term Care Residents and Their Potential Proxies, Arch Intern Med 1989;149:1367–72; Uhlmann, R.F., Pearlman, R.A., Cain, K.C., “Physicians and Spouses' Predictions of Elderly Patients' Resuscitation Preferences,” J. Gerontol 1988; 43:M115–M121.CrossRefGoogle Scholar
Cruzan v. Missouri Department of Health 497 U.S.-, III L. ed. 2d 224, 110 S. Ct. 2841 (1990); Annas, G.J., “The Long Dying of Nancy Cruzan,” Law Medicine & Health Care 1991; 19:52–9; Oventlicher, D., “The Right to Die after Cruzan,” JAMA 1990;264:2444–6; Weir, R.F., Gostin, L., “Decisions to Abate Life-Sustaining Treatment for Non-Autonomous Patients: Ethical Standards and Legal Liability for Physicians after Cruzan,” JAMA 1990;164:1846–53; Lo, B., Steinbrook, R., “Beyond the Cruzan Case: The U.S. Supreme Court and Medical Practice,” Ann Intern Med 1991;114:895–901; See Rouse, , supra note 10; Pawlson, L.G., “Impact of the Cruzan Case on Medical Practice,” Law Medicine & Health Care 1991;19:69–71; Sprung, C.L., “The Cruzan Decision and Critical Care Physicians,” Crit Care Med 1991;19:598–99.CrossRefGoogle Scholar
Kodish, E., Lantos, J., Stocking, C. et al., “Bone Marrow Transplantation for Sickle Cell Disease: A Study of Parents' Decisions,” N Engl J Med 1991;325:1349–53.CrossRefGoogle Scholar
Baron, C.H., “Why Withdrawal of Life-Support for PVS Patients Is Not a Family Decision,” Law Medicine & Health Care 1991;19:73–5.CrossRefGoogle Scholar
Krischer, J.P., “Indexes of Severity: Underlying Concepts,” Health Services Research, Summer 1976, pp 143–57; Knaus, W.A., Wagner, D.P., Draper, E.A., “The Value of Measuring Severity of Disease in Clinical Research on Acutely Ill Patients,” J Chron Dis 1984;37:455463; Knaus, W.A., Draper, E.A., Wagner, D.P., Zimmerman, J.R., “Apache II: A Severity of Disease Classification System,” Crit Care Med 1985;13:818–29; Knaus, W.A., Wagner, D.P., Lynn, J., “Short Term Mortality Predictions for Critically Ill Hospitalized Adults: Science and Ethics,” Science 1991;254:389–94; Knaus, W.A., Wagner, D.P., Draper, E.A. et al., “The Apache Ill Prognostic System; Risk Prediction of Hospital Mortality for Critically Ill Hospitalized Adults,” Chest 1991;100:1619–36.Google Scholar
Kalb, P.E., Miller, D.H., “Utilization Strategies for Intensive Care Units,” JAMA 1989;261:2389–95; Aaron, H., Schwartz, W.B., “Rationing Health Care: The Choice Before Us,” Science 1990; 247(4941):418–22;Fuchs, V.R., “A More Effective, Efficient, and Equitable System,” West J Med 1976:125:3–5; Singer, D.E., Carr, P.L., Mulley, A.G., Thibault, G.E., “Rationing Intensive Care—Physician Responses to a Resource Shortage,” N Engl J Med 1983;309:155–60.CrossRefGoogle Scholar
Tomlinson, T., Brody, H., “Futility and the Ethics of Resuscitation,” JAMA 1990;264:12761280.CrossRefGoogle Scholar
In re Helga Wanglie, Fourth Judicial District (Dist. Ct., Probate CT., Div.) PX-91-283. Minnesota, Hennepin County (1991); Miles, S.H., “Informed Demand for “Non-Beneficial” Medical Treatment,” N Engl J Med 1991;315:512–5.CrossRefGoogle Scholar
Id., Miles.Google Scholar
Youngner, S.J., “Orchestrating a Dignified Death in the Intensive-Care Unit,” Clin Chem 1990;36:1617–22.CrossRefGoogle Scholar
Weil, M.H., Weil, C.J., Rackow, E.C., “Guide to Ethical Decision-Making for the Critically Ill: The Three R's and Q.C.,” Crit Care Med 1988;16:636641.CrossRefGoogle Scholar
Smedira, N.G., Evans, B.H., Grais, L.S. et al., “Withholding and Withdrawal of Life Support from the Critically Ill,” N Engl J Med 1990;322:309–15; Brett, A.S., McCullough, L.B., “When Patients Request Specific Interventions: Defining the Limits of the Physician's Obligation,” N Engl J Med 1986; 315: 1347–51; Wanzer, S.H., Adelstein, S.J., Cranford, R.E. et al., “The Physicians' Responsibility towards Hopelessly Ill Patients,” N Engl J Med 1984;311:334.CrossRefGoogle Scholar
Lo, B., Rouse, F., Dornbrand, L., “Family Decision Making on Trial: Who Decides for Incompetent Patients?” N Engl J Med 1990; 322:1228–32; Paris, J.J., Reardon, F.E., “Physician Refusal of Requests for Futile or Ineffective Interventions,” Cambridge Quarterly of Healthcare Ethics (1992),2,127–134.CrossRefGoogle Scholar
Omnibus Budget Reconciliation Act of 1990. Publ L. No. 101–508 Section 4206, 4751 (codified in scattered sections of 42 U.S.C., especially Section 1395cc, 139ba (West Suppl 1991)).Google Scholar
Tomlinson, T., Brody, H., “Futility and the Ethics of Resuscitation,” JAMA 1990;264:12761280.CrossRefGoogle Scholar
New York State Task Force on Life and the Law, When Others Must Choose: Deciding for Patients Without Capacity, Chapter 10, March 1992, pp. 157171.Google Scholar
American Thoracic Society Official Statement, “Withholding & Withdrawing Life Sustaining Therapy,” Am Rev Respir Dis 1991; 144:726731.CrossRefGoogle Scholar
New York State Task Force, supra note 26, Chapter 14, pp. 195204.Google Scholar
Kutner, J.S., Ruark, J.E., Raffin, T.A., “Defining Patient Competence for Medical Decision Making,” Chest 1991;100:1404–9; Rouse, F., “The Role of State Legislature After Cruzan: What Can—and Should—State Legislatures Do?” Law Medicine & Health Care 1991;19:83–90.CrossRefGoogle Scholar
Pawlson, L.G., “Impact of the Cruzan Case on Medical Practice,” Law Medicine & Health Care 1991;19:6972.CrossRefGoogle Scholar
Omnibus Budget Reconciliation Act of 1990, Publ L. No. 101–508 Section 4106, 4751 (codified in scattered sections of 41 U.S.C., especially Section 1395cc, 139ba (West Suppl 1991)); Pawlson, L.G., “Impact of the Cruzan Case on Medical Practice,” Law Medicine & Health Care 1991;19:6972; Sprung, C.L., “The Cruzan Decision and Critical Care Physicians,” Crit Care Med 1991;19:598–99.CrossRefGoogle Scholar
Jonsen, A.R., Siegler, M., Winslade, M.J., Clinical Ethics—A Practical Approach to Ethical Decisions in Clinical Medicine, 2nd ed., MacMillan Publishing Co., New York 1986, pp 202.Google Scholar
Crowley, L.T., Young, E., Raffin, T.A., “Care of the Dying: An Ethical and Historical Perspective,” Critical Care Medicine, 1992;20:14731482; Jones, W.H.S., “Hippocrates: The Art,” Hippocrates, Vol 2, Harvard University Press, Cambridge, 1959, p 193.Google Scholar