MEDICALFUTILITYPhysiologic futility: The treatment will notachieve a physiologic goal.Qualitative futility: the treatment will notachieve a certain quality of life that isacceptable to the patient.Imminent-Demise futility: in spite ofintervention the patient will die in thenearfuture
MEDICAL FUTILITY Physiologic futility: The treatment will not achieve a physiologic goal. Qualitative futility: the treatment will not achieve a certain quality of life that is acceptable to the patient. Imminent-Demise futility: in spite of intervention the patient will die in the near future
WITHDRAWAL OFMEDICALTREATMENTDiscontinuation of life-sustainingtreatmentDifferent from never starting or offeringtreatmentWithdrawal of treatment is not the sameas withdrawal of care
WITHDRAWAL OF MEDICAL TREATMENT - Discontinuation of life-sustaining treatment - Different from never starting or offering treatment - Withdrawal of treatment is not the same as withdrawal of care
WITHDRAWAL OFMEDICALTREATMENTDecision-making hierarchyPatientAdvancedirectivePower of attorneyNext of kin spouse, children..Physician and court order
WITHDRAWAL OF MEDICAL TREATMENT Decision-making hierarchy • Patient • Advance directive • Power of attorney • Next of kin —— spouse, children. • Physician and court order
WITHHOLDING AND WITHDRAWALOFMEDICALTREATMENT PASSIVEEUTHANASIA)The withholding, or withdrawing, of treatmentis widely accepted as morally right in manycircumstances. And it is protected by law inEngland, the US, Canada, and many othercountries. There are two grounds on which itis accepted:(1) that it is in the patient's best interests; and(2) that it is in accord with the patient's wishes
WITHHOLDING AND WITHDRAWAL OF MEDICAL TREATMENT (PASSIVE EUTHANASIA) The withholding, or withdrawing, of treatment is widely accepted as morally right in many circumstances. And it is protected by law in England, the US, Canada, and many other countries. There are two grounds on which it is accepted: (1) that it is in the patient’s best interests; and (2) that it is in accord with the patient’s wishes
For example, a 60-year-old man with diabetesand hypertension develops renalinsufficiency to the point of needingdialysis. He is equivocal about spendingthe rest of his life on dialysis, but he agreesto start. The patient is not depressed and isfully alert. Six months after startingdialysis, he comes to realize very clearlythat he absolutely does not wish tocontinue. You have no doubt that thepatient has full capacity to understand theimplications of this decision. What shouldyou do?
For example, a 60-year-old man with diabetes and hypertension develops renal insufficiency to the point of needing dialysis. He is equivocal about spending the rest of his life on dialysis, but he agrees to start. The patient is not depressed and is fully alert. Six months after starting dialysis, he comes to realize very clearly that he absolutely does not wish to continue. You have no doubt that the patient has full capacity to understand the implications of this decision. What should you do?