Thomas E. Finucane, MD
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Finucane TE. Advance Directives, Due Process, and Medical Futility. Ann Intern Med. 2004;140:403. doi: 10.7326/0003-4819-140-5-200403020-00022
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Published: Ann Intern Med. 2004;140(5):403.
TO THE EDITOR:
Discussing Texas's legal rules for “resolution of futility by due process,” Fine and Mayo (1) cite 3 legal cases: Wanglie (2), Baby K (3), and Gilgunn (4). They contrast the first 2, where family wishes were upheld over professionals' claims of futility, with the third, where the family's request was not honored.
Careful use of the word futility is essential. In the Wanglie and Baby K cases, the patients continued to live because of intensive care unit treatment, albeit with severe, hopeless cognitive impairment. The futility claims were based on quality of life and were supported by the sense that resources were being unjustly allocated. In Gilgunn, in contrast, the likelihood that the patient would continue to live after attempted resuscitation was vanishingly small. The case study on which Fine and Mayo (1) based their discussion is more like the Baby K and Wanglie cases. “The treatment team believed that S.H. could be kept alive for months or more in the ICU [intensive care unit]. … The team's opinion was that treatment was ‘futile,’ and they wished to … withdraw life-sustaining treatment.” The ethics committee sided with the treatment team, and the eldest daughter “agreed to withdrawal of life support and the patient died peacefully.”
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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