A recording of this presentation can be found HERE (will be added as soon as it is available).
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Thanks to our Sutter bioethicist, Dr. Garson Leder, for a thoughtful presentation on Non-Beneficial Treatment. This is a heavy (and heady) topic, and I recommend you listen to the presentation if you want to get into the weeds on bioethical conundrums.
If you just want the brief notes, keep reading!
Any good ethics lecture begins with terms and definitions:
- Medical Futility: a treatment is highly unlikely to benefit a patient or achieve a meaningful goal
- quantitative futility: the chance of expected benefit is judged to be so low as to not justify treatment (sometimes but not always defined loosely as <1% chance of success, though numbers as high as a surgery that only has 30% chance of success may also fall into this category)
- qualitative futility: the quality of the expected benefit is judged to not justify treatment (quality as defined by who?)
- physiological futility: the treatment cannot achieve its intended purpose
- Moral authority: the right to make a decision for another person.
- What gives physicians the power to be the decision-maker/moral authority?
- medical knowledge and experience (medical professionals are often right about likely outcome/course)
- don't patients still have right to make other/different decisions for themselves (i.e. do we have moral standing to unilaterally refuse treatment?)
(Resource allocation-- the question of should one be using limited resources to accomplish a specific goal-- is a different question)
A few pearls
-Continuing treatment is, no matter what, a decision
-Continuing treatment is, no matter what, a decision
-Consider using the term "potentially inappropriate" rather than medically futile or even non-beneficial
-CA law supports the right of physicians to decline to continue care if it is deemed medically ineffective and/or is considered with "standard of care"
-Most conflicts about non-beneficial treatment can be resolved with clear communication AND time.
