The hospital should always defer to the patient and family that has an advanced directive in place, and if the patient cannot speak for themselves but has an advanced directive, then a proxy must make the decision. The only case where the hospital should be allowed to make the decision on futile care is in the absence of a proxy, in the absence of an advanced directive, and only if it is in the best interest of the patient.
In this psychological-based model, the healthcare professional and hospital is put in the position of negotiating with the family and/or patient. Burns and Truog (2007) state that in these situations the healthcare professional should always follow the wishes of the patient's family in futile care efforts (Burns & Truog, 2007). However, that view places a burden on the healthcare professional to compromise medical principles when that professional deems the care to be inappropriate and ultimately unnecessary (Forde, 1998).
In brief, there may be situations that are very clearly defined as situations where futile care is not warranted; in other situations the issue may not be so easy to determine and requires more objective clarification. Marsden (1995) examined data from a six-year time period of cardiac arrests for the Scottish Ambulance Service. The finding was that those patients with a non-shockable rhythm never survived resuscitation attempts. The results of the Marsden study led to the development of guidelines for ambulance personnel in Scotland given in the form of a quick algorithm that could be used on scene (Marsden, Ng, Dalziel, & Cobbe, 1995).
Conclusion
The hospital, in designing a futile care policy, must adhere to state ethical standards and state laws. In the State of Massachusetts, for example, it is punishable...
Therefore it is the onus of the hospital to have a bioethics committee to oversee compliance of its healthcare professionals with state regulations and in keeping with the wishes of the family and patient in question. Clearly there will be gray area in attempting to figure out what the right thing to do is in certain situations, yet having compliance guidelines such as advanced directives, adherence to state laws, and recognizing the autonomy of patients and the rights of families will ultimately dictate the outcome in futile care cases.
References
Burns, J., & Truog, R. (2007). Futility: A Concept in Evolution. Chest, 1987-1993.
Forde, R. (1998). Who is to define the futility of treatment -- the patient or the physician? Tidsskr nor Laegeforen (Norwegian), 2652-2654.
Jonson, a., Seigler, M., & Winslade, W. (2002). Clinical Ethics 5th ed. New York, NY: McGraw-Hill.
Lachman, V. (2009). Ethical Challenges in Health Care: Developing Your Moral Compass. New York, NY: Springer Publishing.
Marco, C., Larkin, G., Moskop, J., & Derse, a. (2000). Determination of "futility" in emergency medicine. Annals of Emergency Medicine, 604-612.
Marsden, a., Ng, G., Dalziel, K., & Cobbe, S. (1995). When is it futile for ambulance personnel to initiate cardiopulmonary resuscitation? British Medical Journal, 49-51.
Massachusetts Office of Health and Human Services. (2011). Decision-making Guidelines. Retrieved January 18, 2011, from Massachusetts Office of Health and Human Services: http://www.mass.gov/?pageID=eohhs2terminal&L=6&L0=Home&L1=Provider&L2
