Medical Futility and the Vulnerables  Research Proposal

Excerpt from Research Proposal :

It is feared that religious differences in decisions regarding when to withhold treatment are being ignored by the courts.

The social and legal issues are highlighted in cases that involve pre-term infants. In the elderly, the cultural consensus is that these persons have lived their life and are close to death anyway. However, in the case of a pre-term infant, the issue is raised of what measures should be taken to preserve life, particular when there is a lack of resources (Seri and Evans 2008). In the case of premature infants, significant cases exist to aid in the establishment of criteria to predict survival rates. If the survival probability is too low, resources are typically saved for those infants that have a greater chance for survival. For instance, it is the general rule that babies under 23-week and that weigh less than 500 grams are unlikely to survive. However, babies over 25 weeks and that weigh at least 600 grams have a high likelihood of survival and therefore warrant interventions to save their lives (Seri and Evans 2008). The real question lies in infants that are in the grey zone between these two extremes. This is similar to the healthy, elderly woman discussed earlier.

This exploration of the topic of medical futility and the decision to withhold care focused on the perspective of the health care facility and the individual doctor who must make the decision. The decision to withhold care has a significant impact on the doctor's future and ability to practice medicine. The doctor himself is under the greatest legal and moral liability in these cases, as they are the ones to make the important decisions. This research examined the question of medical futility using an example of a case that falls into the grey zone of decision making in these regards.

The literature found several sets of criteria that have been developed with the intention of aiding doctors in their decision to withhold life saving treatment. In the past, this decision has been largely decided by the personal opinions and beliefs of the doctors. In the UK, the courts can intervene in cases of coma. However, many times, the decisions must be made in a split second, particularly in the emergency room setting. Cultural and religious differences between the doctor, patient, staff, and the patient's family may cloud the decision. In practice, it is the decision of the doctor that holds the most weight from a legal standpoint.

The need to develop a set of viable standards and guidelines for helping doctors make life saving or ending decisions is clear. However, current attempts to develop these criteria has only resulted in more controversy over bias on the part of the doctor. No studies could be identified that examined the opinions and criteria used by doctors in the UK to help determine who is treated and who does not. A study similar to this was found concerning Japanese doctors, but none was found that was culturally relevant to doctors in the UK. There is a clear need for the development of criteria for making life-ending decisions among UK doctors.

The first step in arriving at a consistent consensus is to determine what criteria a majority of the doctors in he UK use to determine whether to withhold treatment or not. This study will survey emergency room doctors, as they must often be the sole person responsible for making those decisions. They often do not have the luxury of a court making the decision, as emergency room decisions do not have the luxury of a sufficient period to obtain a court decision. This study will examine the criteria used by doctors in determining who is treated and who does not when resources are limited.

This study is a necessary step in arriving at clinically valid consensus regarding the criteria that doctors currently use to determine who gets bed space when bed space is limited. It will pay particular attention to the factor of age and when doctors feel that lifesaving measures are futile in terms of a patient's age. This study will provide valuable insight into the decisions that are currently being made regarding age-related emergency room decisions and use of resources. It is the first step in the development of standards of care concerning withholding of treatment for the elderly.


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