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    Tuesday, January 07, 2003

    Resistance is Futile: Is there a new movement within medicine to save money at the expense of patients? National Review Online says “yes,” and it isn’t the brain child of insurance companies, but of hospitals and doctors and bioethicists:

    As you read these words, quietly, slowly, inexorably, mostly behind the closed doors of hospital ethics committees, "futile care" or "inappropriate care" protocols are being put into place in hospitals throughout the country. The first time most patients and their families become aware that doctors are being given the right to say "no" to wanted medical treatment (other than comfort care) is during a medical crisis when they are at their most defenseless and vulnerable.

    The article is about the trend among hospitals to put policies in place for dealing with the issue of futile care - care that’s not necessarily in the best interest of the patient. The article goes on to characterize futile care policies of hospitals as cost-saving measures, a means of rationing healthcare. This isn’t necessarily so. Nor is it a “stealth movement.” Futile care policies exist to help mediate disagreements between families and physicians. There are times when care is futile, and even harmful. But, for whatever reason, the family can’t accept that. (Sometimes it’s just too hard to let go.) Consider, for example this hypothetical (and admittedly overly optimistic) case of a child with a terminal illness. Or this very real, and much messier, instance of a family that can’t agree on treatment. Without futile care policies, there would be no forum for the family to express their view - outside the courts.

    As in any system, there is the danger of abuse. A committee made up overwhelmingly of hospital employees, for example, could conceivably have the hospital’s best interest at heart rather than the patient’s or the family’s. (The constant references to wanting to free up a hospital bed for more acutely ill people with better hopes of survival in the second case above is an example.) But, the purpose and intent of the futile care policies truly isn’t to deny care. It’s to mediate. (Thanks to J. Bowen)

    posted by Sydney on 1/07/2003 08:15:00 AM 0 comments


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