Physician refusal of requests for futile or ineffective interventions

Several recent articles raise an issue long unaddressed in the medical literature: physician compliance with patient or family requests for futile or ineffectice therapy. Although they agree philosophically that such treatment ought not be given, most physicians have followed the course described by Stanley Fiel, in which a young patient dying of cystic fibrosis was accepted “for evaluation” by a transplant center even though he has already passed the threshold of viability as a candidate for a heart-lung transplant. Dr. Fiel reported this action was taken not in the hope of doing the transplant but so that the family could assure themselves they had done “everything possible.” The patient, after a long and stressful cross-country flight, arrived at the hospital in respiratory failure. He died soon thereafter far from home and familiar surroundings.

Withholding of nutrition and fluids in the hopelessly ill patient

This article is a review of recent court cases concerned with appropriate treatment of dying or irreversibly comatose patients, specifically, withholding of nutrition and fluids. In these cases the various courts relied on the advice first found in the Hippocratic corpus and expanded on through the centuries. The statement found in the exhortation of the California Court of Appeal in Bouvia: "Provide as large a measure of dignity, respect, and comfort as possible to every patient for the remainder of his days, whatever be their number" should be our guide in caring for the infants entrusted to us.

Allocation of scarce resources: a challenge for American medicine

We must decide as a society how much we can afford, or at least are willing to spend, on health care as opposed to other goods. More importantly, how shall we decide which individual medical needs are to be met?

Ethics committees in critical care

Ethics committees have emerged as a way for institutions to evaluate and resolve some of the difficult decisions facing critical care medicine. This article examines their origin, scope, function, and potential problems.

Terminating treatment for newborns: a theological perspective

In a recent issue of the Hastings Center Report, Paul and Marilyn Bridge discuss the difficulties and frustrations they encountered with the physicians and hospital concerning a proposal to withhold treatment from their severely defective newborn son, Christopher. Born some three months prematurely, he had signs of viral encephalitis. His long-term outlook was quite dim: he had severe mental retardation, and would possibly suffer from uncontrollable convulsions, deafness, blindness, and quadraplegia. Brain damage was extensive, and was thought to extend to the cortex. While Christopher was not terminally ill nor in any immediate danger of dying, the pediatrician suggested that there would be situations in the future which perhaps ought not be treated, such as infection or the aspiration of food. The family rejected that option, and insisted on treatment until Christopher, on his 75th day of life, suffered cardiac arrest. After three days of ventilator support, the parents agreed to discontinue the heroic means supporting their son whom they now believed to be terminally ill and approaching brain death.