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Indiana Univ Pr; Bioethicists, physicians, and policymakers. The book provides context for, definitions in, and analysis of the concept of medical futility.
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After rejecting the idea of futility as a justification for unilateral decisions by physicians about care, the concluding chapter attempts to reframe the issue and calls for exploration of other grounds for refusal to provide certain treatments and for wider social debate. A bibliography of books, journal articles, position papers, and relevant court cases and statutes is provided.
When doctors say No : the battleground of medical futility / Susan B. Rubin - Details - Trove
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The Battleground of Medical Futility. When Doctors Say No. Copyright by the Journal of Medical Ethics. Ghost Of The Past: Elliot Lankford Mystery Series Book 1. Discover the dark secrets of human psychology and the real methods people use to influence anyone at will Paleo Diet for Beginners: Lose Weight and Live Healthy!
From Publishers Weekly In this extensively researched and footnoted dissertation, Rubin, a medical ethicist, argues that medical futility? Indiana University Press; 1 edition October 22, Language: Related Video Shorts 0 Upload your video. Share your thoughts with other customers. Write a customer review. There was a problem filtering reviews right now.
Please try again later. This book came without the cover and it was not indicated initially. Rubin When Doctors Say No: R83 Medical call number: W50Rw This book is a sustained attack on the concept and practice of declaring medical futility and therefore discontinuing treatment. The author is trained in medical ethics and has worked as an ethical consultant. She has read the literature on medical futility and finds that no consistent position or philosophy had yet emerged. Different doctors were coming to different conclusions.
Sometimes the judgment of 'futility' was based on matters other than science. For example, how much should we treat an alcoholic, seeing that the self-destructive behavior is likely to continue? Even if no patient has ever recovered as the result to a certain treatment, should it still be tried? When asked, patients and their families mention factors the doctor would never have considered in any way. For example, they have religious beliefs about the proper time to die. They want to postpone death until a relative can arrive from a distant city.
As of the writing of this book, there was no systematic way to decide when a proposed course of treatment is futile. And there are many different meanings of "futile". Doctors sometimes consult ethics committees, but usually they decide on the basis of medical knowledge whether a certain treatment will work or not.
This book takes the opposite position from most books on medical futility. This reviewer believes that the author began with a bias against any declaration of medical futility. But such thinking is a good corrective for those positions that would 'pull the plug' too soon.
In one case the family wanted to sustain an infant in PVS, who would never think or feel. Should these parents be sustained in a choice that would not be taken by most people?
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Their infant would never become a person. They could take care of it in a bed at home, but they would need additional medical care whenever some disease developed. But what would happen to this individual in PVS when the parents die? Would they expect the state to take over the care of an adult body in PVS? These parents probably did not think that far ahead.
They merely wanted to 'love' their baby, even if it would never respond to anything they did.
When Doctors Say No. The Battleground of Medical Futility
This case illustrates a larger issue: When it comes to letting go of a loved one, some families cannot be rational. They will insist on supportive care even when there is no hope. Sometimes religious views figure in such decisions. For example, the family members might be praying for a miracle. And they want to keep using the life-support systems until God has an opportunity to hear their prayers and cause a cure that medical science would never be able to explain. People have a right to such religious beliefs, but in the opinion of this reviewer, they do not have a right to use public funds to support a hopeless case.
A Medical Futility Monitor would make decisions based only on science. But irrational beliefs could be taken into account as long as they did not make much difference in the care plan. For example, one Asian woman believed that her family would be cursed for 5 generations if she died in a certain month.
A few more days on life-support was a great relief to her. And the additional cost to taxpayers was small. This reviewer hopes that a Medical Futility Monitor could take such small variations into account, even when the beliefs have no scientific basis.
However, if religious beliefs would lead to keeping a hopeless patient 'alive' indefinitely, at public expense, then the MFM must decide in the public interest, based on science. This book should be read by anyone thinking of becoming a Medical Futility Monitor.
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