Hostname: page-component-5db58dd55d-f6s65 Total loading time: 0 Render date: 2026-06-04T14:41:37.500Z Has data issue: false hasContentIssue false
  • English
  • Français

Healthcare Provider Limitation of Life-Sustaining Treatment without Patient or Surrogate Consent

Published online by Cambridge University Press:  01 January 2021

Andrew Courtwright  and
Emily Rubin
Get access Rights & Permissions [Opens in a new window]

Abstract

In June 2015, the major North American and European critical care societies released new joint guidelines that delineate a process-based approach to resolving intractable conflicts over the appropriateness of providing or continuing LST.2 This article frames the new guidelines within the history, ethical arguments, legal landscape, and empirical evidence regarding limitation of LST without surrogate consent in cases of intractable conflict.

Information

Type
Independent Articles
Information
Journal of Law, Medicine & Ethics , Volume 45 , Issue 3: Symposium - Controversies in Clinical Research Ethics , Fall 2017 , pp. 442 - 451
Copyright
Copyright © American Society of Law, Medicine and Ethics 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Courtwright, A. M., Brackett, S., Cadge, W., Krakauer, E. L., and Robinson, E. M., “Experience with a Hospital Policy on Not Offering Cardiopulmonary Resuscitation When Believed More Harmful Than Beneficial,” Journal of Critical Care 30, no. 1 (2015): 173-177; Casarett, D. and Siegler, M., “Unilateral Do-Not-Attempt-Resuscitation Orders and Ethics Consultation: A Case Series,” Critical Care Medicine 27, no. 6 (1999): 1116–1120.Google Scholar
Bosslet, G. T., Pope, T. M., Rubenfeld, G. D., et al., “An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units,” American Journal of Respiratory and Critical Care Medicine 191, no. 11 (2015): 1318-1330.CrossRefGoogle Scholar
In re Quinlan, 70 N.J. 10, 355 A.2d 647 (NJ 1976).Google Scholar
Cruzan v. Director, Missouri Department of Health, 497 U.S.Google Scholar
Lundberg, G. D., “American Health Care System Management Objectives: The Aura of Inevitability Becomes Incarnate,” JAMA 269, no. 19 (1993): 2554-2555.Google Scholar
Schneiderman, L. J., Jecker, N. S., and Jonsen, A. R., “Medical Futility: Its Meaning and Ethical Implications,” Annals of Internal Medicine 112, no. 12 (1990): 949-954.CrossRefGoogle Scholar
Veatch, R. and Spicer, C. M., “Medically Futile Care: The Role of the Physician in Setting Limits,” American Journal of Law & Medicine 18, nos. 1-2 (1992): 15-36; Truog, R. D., Brett, A. S., and Frader, J., “Sounding Board: The Problem with Futility,” New England Journal of Medicine 356, no. 4(1992): 1560–1554; Veatch, R. M., “Why Physicians Cannot Determine If Care Is Futile,” Journal of the American Geriatric Society 42, no. 8 (1994): 871–874; Youngner, S. J., “Who Defines Futility?” JAMA 260, no. 14 (1988): 2094-1095.Google Scholar
Annas, G. J., “Asking the Courts to Set the Standard of Emergency Care: The Case of Baby K,” New England Journal of Medicine 330, no. 21 (1994): 1542-1545; Brody, H., “The Physician's Role in Determining Futility,” Journal of the American Geriatric Society 42, no. 8 (1994): 875–878; Gampel, E., “Does Professional Autonomy Protect Medical Futility Judgments?” Bioethics 20, no. 2 (2006): 92-104; Tomlinson, T. and Brody, H., “Futility and the Ethics of Resuscitation,” JAMA 264, no. 10 (1990): 1276–1280.Google Scholar
Blackhall, L. J., “Must We Always Use CPR?” New England Journal of Medicine 317, no. 20 (1987): 1281-1285; Hilberman, M., Kutner, J., Parsons, D., and Murphy, D. J., “Marginally Effective Medical Care: Ethical Analysis of Issues in Cardio-pulmonary Resuscitation (CPR),” Journal of Medical Ethics 23, no. 6 (1997): 361–367.Google Scholar
Helft, P. R., Siegler, M., and Lantos, J., “The Rise and Fall of the Futility Movement,” New England Journal of Medicine 343, no. 4 (2000): 293-296; Cotler, M. P., Piven, M., and Gregory, D. R., “Futility: Is Definition the Problem? Part I,” Cambridge Quarterly of Healthcare Ethics 2, no. 2 (1993): 219–224; Gatter, R. A. and Moskop, J. C., “From Futility to Triage,” Journal of Medicine and Philosophy 20, no. 2 (1995): 191–205.Google Scholar
Halevy, A. and Brody, B. A., “A Multi-institution Collaborative Policy on Medical Futility,” JAMA 276, no. 7 (1996): 571-574.CrossRefGoogle Scholar
American Medical Association, Opinion 2.035 (1994).Google Scholar
Plows, C. W., Tenery, R. M., Hartford, A., et al., “Medical Futility in End-of-Life Care: Report of the Council on Ethical and Judicial Affairs,” JAMA 281, no. 10 (1999): 937-941.Google Scholar
Tex HS Code Ann. § 166.046 (1999).Google Scholar
See Bosslet, et al., supra note 2.Google Scholar
Id., at 1326.Google Scholar
Id., at 1324.Google Scholar
Palda, V. A., Bowman, K. W., Mclean, R. F., and Chapman, M. G., ‘“Futile’ Care: Do We Provide It? Why? A Semistructured, Canada-Wide Survey of Intensive Care Unit Doctors and Nurses,” Journal of Critical Care 20, no. 3 (2005): 207-213.Google Scholar
Uniform Health Care Decisions Act (1993).Google Scholar
Va. Code Ann. 5 54.1-2990(A) (2005); Conn. Gen. Stat. Ann. 5 19a-571(a) (2002).Google Scholar
Cal Prob. Code § 4734 (1999).Google Scholar
Mass. Gen. Laws Ann. Ch. 201D, § 14 (2005); Neb. Rev. Stat. § 30-3428 (2007).Google Scholar
755 Ill. Comp. Stat. § 40/20 (2009).Google Scholar
Oh. Rev. Code Ann. § 1337.16(B)(2)(a) (2012).Google Scholar
Idaho Code Ann. § 39-4513 (2015); Del Code Tit. 16 §25-10 (1989).Google Scholar
Ark. Code § 20-6-109 (2014).Google Scholar
Pope, T. M., “Medical Futility Statutes: No Safe Harbor to Uni-laterally Refuse Life-Sustaining Treatment,” Tennessee Law Review 75, no. 1 (2007): 1-81.Google Scholar
In re Conservatorship of Helga Wanglie, No. PX-91-283 (D. Minn. P. Div. 1991).Google Scholar
Rideout v. Hershey Medical Center, 30 Pa. D. & C.4th 57 (Ct. Com. Pl. 1995).Google Scholar
Matter of Baby K, 832 F. Supp. 1022 (E.D. Va. 1993).Google Scholar
Matter of Baby K, 16 F.3d 590 (4th Cir. 1994), cert. denied, 115 S. Ct. 91 (1994).Google Scholar
Bryan v. Rectors and Visitors of Univ. of Virginia, 95 F.3d 349 (4th Cir. 1996).Google Scholar
Hudson v. Texas Children's Hosp., No. 352.526 (Tx. Prob. Ct. 2004)Google Scholar
Lightfoot, L., “The Ethical Health Lawyer,” Journal of Law, Medicine & Ethics 33, no. 4 (2005): 851-856.CrossRefGoogle Scholar
Nikolouzos v. St. Luke's Episcopal Hosp., 162 S.W.3d 678 (Tx. App. 2005).Google Scholar
Dunn v. Methodist Hospital (Harris County, Tex., Nov. 2015).Google Scholar
Gilgunn v. Massachusetts General Hospital, SUCV92-4820 (Ma. Super. Ct. 1995).Google Scholar
See Pope, , supra note 27, at 75-76.Google Scholar
Estate of Goldberg v. Nimoityn, Civil Action No. 14-980 (E.D. Pa. Jun 17, 2016).Google Scholar
Marsala v. Yale New Haven Hospital (Milford Sup. Ct., Conn. Mar. 2015, ruling on partial summary judgment).Google Scholar
Marsala v. Yale-New Haven Hospital, Inc., 142 A.3d 316, 166 Conn. App. 432 (App. Ct. 2016).Google Scholar
Siner v. Kindred Hospital Limited Partnership, 51 N.E.3d 1184 (Ind. 2016).Google Scholar
2015 WL 9608853 (Tex. Dist.) (Trial Pleading).Google Scholar
O'Callaghan, N., “Dying for Due Process: The Unconstitutional Medical Futility Provision of the Texas Advance Directives Act,” Baylor Law Review 60, no. 2 (2008): 527-611.Google Scholar
Wojtasiewicz, W. E., “Damage Compounded: Disparities, Distrust, and Disparate Impact in End-of-Life Conflict Resolution Policies,” American Journal of Bioethics 6, no. 5 (2006): 8-12; Pope, T. M., “The Growing Power of Healthcare Ethics Committees Heightens Due Process Concerns,” Cardozo Journal of Conflict Resolution 15, no. 1 (2015): 425–569; Werth, J. L., “Concerns about Decisions Related to Withholding/Withdrawing Life-Sustaining Treatment and Futility for Persons with Disabilities,” Journal of Disability and Policy Studies 16, no. 1 (2005): 31–37; Rosoff, P. M., “Institutional Futility Policies Are Inherently Unfair,” Hospital Ethics Committee Forum 25, no. 3 (2013): 191–209.CrossRefGoogle Scholar
Huynh, T. N., Kleerup, E. C., Wiley, J. F., et al., “The Frequency and Cost of Treatment Perceived to Be Futile in Critical Care,” JAMA: Internal Medicine 173, no. 20 (2013): 1887-1894; Meadow, W., Pohlman, A., Frain, L. et al., “Power and Limitations of Daily Prognostications of Death in the Medical ICU for Outcomes in the Following 6 Months,” Critical Care Medicine 42, no. 11 (2014): 2387–2392.Google Scholar
Smith, M. L., Gremillion, G., Slomka, J., and Warneke, C., “Texas Hospitals' Experience with the Texas Advance Directives Act,” Critical Care Medicine 35, no. 5 (2007): 1271-1276.Google Scholar
See Courtwright et al., supra note 1.Google Scholar
Truog, R. D., “Tackling Medical Futility in Texas,” New England Journal of Medicine 357, no. 1 (2007): 1-3.Google Scholar
Hoffman, L. C., “Hospital Medical Futility Policy & the Severely Disabled Child: Is Disability a Death Sentence?” Hamline Law Review 36, no. 2 (2014): 275-298.Google Scholar
See Pope, , supra note 27, at 46.Google Scholar
See Boslett, et al., supra note 2, at 1332-1333.Google Scholar
Misak, C. J., White, D. B., and Truog, R. D., “Medical Futility: A New Look at an Old Problem,” CHEST 146, no. 6 (2014): 1667-1672.CrossRefGoogle Scholar
Wilkinson, D., Truog, R., and Savulescu, J., “In Favour of Medical Dissensus: Why We Should Agree to Disagree about Endof-Life Decisions,” Bioethics (2015), available at <http://onlinelibrary.wiley.com/doi/10.1111/bioe.12162/full> (last visited August 9, 2017).+(last+visited+August+9,+2017).>Google Scholar
Tarzian, A. J. and ASBH Core Competencies Update Task Force, “Health Care Ethics Consultation: An Update on Core Competencies and Emerging Standards from the American Society for Bioethics and Humanities' Core Competencies Update Task Force,” American Journal of Bioethics 13, no. 2 (2013): 3-13.CrossRefGoogle Scholar
See Smith, et al., supra note 47.Google Scholar