Theend-of-life decisions are quite controversial and debates on them maynever come to a conclusion. One of these decisions involves the rightof families and patients to insist on the continuation of medicationthat has been confirmed to be futile by competent health careproviders. Futile treatment is defined as the type of medication thatis considered to be ineffective since the patient has been overcomeby an illness and it is more certain that such a patient will die(Kasman, 2004). This paper presents an argument that family membersand the patient have no right from the economic, social, quality oflife, and legal perspectives to insist on the administration offutile medication.
Thestakeholders’ involvement in the process of decision makingvalidates and increases the acceptance of the conclusions made. Inthe case of decisions on the futility of the treatment processes andtermination of such medications, there are four major stakeholdersinvolved. First, patients may write living wills during their statingwhether they would like to undergo life support medication even if itis futile (Glen, 2015). Secondly, family members may make decisionson behalf of patients who become incompetent before making a livingwill regarding the use of futile medication. Third, health careproviders play an advisory role and have the responsibility ofdetermining whether a given treatment is futile or not. Fourth, thegovernment makes laws regarding the administration of futiletreatment. Fifth, the patient may have appointed surrogates to makehealth decisions on their behalf when they become incompetent.
Althoughthe family members may have some wish for their incompetent patient,the opinion of the rest of the stakeholders counts when determiningthe termination of futile treatment. For example, an appeal by thefamily members to continue a treatment that has been confirmed byhealth care providers to be futile is irrelevant, especially when thepatient had left a previous wish refusing to such treatment (Glen,2015). However, a decision on whether the patient can make a similarclaim, requesting to continue with futile medication can bedetermined using the legal and ethical provisions.
Roleof government and the legislative substantiation
Governmentis among the key stakeholders who determine the legal status ofdifferent medical procedures, including the futile medication.Naturally, human beings fear death and making the end of lifedecisions (such as the termination of futile treatment) is difficultamong the family members, relatives, and close friends. Thesestakeholders may insist on the continuation of futile treatment, notbecause they believe the patient will recover, but out of pity forthe dying patient. To this end, the intervention of the governmentthrough legislations makes it easy for the health care providers todecide when to terminate futile treatment since family members maynever make such decisions (Clark, 2007). This raises a conflict ofinterest between relatives and health care providers, which can onlybe resolved by the law.
Currently,most of the state governments have formulated laws that make it clearthat the health care providers can terminate futile medicationagainst the wishes of legal guardians as long as the patient iscertain to die. For example, the Advance Directive Act made in Texasauthorize health care providers to terminate futile medicationwithout taking account of an otherwise opinion of the family members,as long as it is consistent with the wish of the patient (Clark,2007). In addition, Chapter 166 of the Health and Safety Code allowhealth care providers to terminate futile medication even without theadvanced directive by the patient, provided that they can prove thatthe patient is certain to die (Clark, 2007). This was confirmed inthe case of Sun Hudson, 2005, who suffered from thanatophoricdysplasis and the health care providers was certain that he was goingto die. The doctor removed the breathing tube inconsistent with thewish of Sun’s mother, but the court held that the provider actedwithin the law (Clark, 2007). This confirms that family members andthe patient do not have the legal right to insist on receivingmedication that has been proven to be futile.
Outcomeof terminating futile medication
Fromthe legal perspective, it is evident that health care providers havethe right to terminate futile medication while the patient and thefamily members lacks the legal grounds to insist on the continuationof such treatment. This has both negative and positive outcomes.First, the legal position allows the incompetent patient to die withdignity by reducing the suffering and pain (Connect us FundOrganization, 2015). Secondly, denying the patient and the familymembers the right to push for administration of futile medicationsafe the family and friends from financial, physical, and emotionaldistress, although they may not be able to acknowledge this positiveoutcome in public. Third, the law allows the health care providers toserve other patients who are likely to recover by withdrawing futilemedication from those who will certainly die, which address the issueof the shortage of health care providers.
Onthe negative side, denying the patient and close family members theright to push for futile medication may have short-term emotionaldistress since losing a loved one is naturally a painful experience(Clark, 2007). Litigation is among the most likely negative outcomeof the providers’ decision to terminate futile medication. This isbecause some family members believe that they have more right in thepatient’s decision than the physician when it comes to the end oflife issues. Some may also argue that giving the health careproviders the right to terminate medication that they consider to befutile without considering the opinion of the patient or the familymember takes away the value of life. In overall, although denyingfamily members and the patient the right to insist on theadministration of futile medication has both the negative andpositive outcomes, it is evident that it benefits the patient andfamily members emotionally and economically.
Thecost of administering futile medication is considered to besubstantially higher than treating normal patients. This is becausefutile care, in most cases, is mean to sustain the life of a delicatepatient. A study conducted by Huynh, Kleerup, Willey & Garber(2013) indicated that a hospital spent $ 2.6 million a day toadminister futile treatment to about 134 patients. A similar studyindicated that a hospital can save about $ 157,380 ($ 324.49 per bed)by reducing the number of ICU patients by 485 (Rubenfeld, 2014). Thisproves the fact that it is economically viable to terminate futilemedication and deny patients and parents the right to insist on suchmedication when it is certain that the patient will not recover fromthe current illness.
Issuesof quality of life
Thequality of life of the dying patient is controversial, especiallywhen the issue of terminating or continuing with futile medication isintroduced. However, there are incidents in which the quality of lifecan be protected well when futile treatment is terminated than whencontinuing with unproductive medication. According to Hospice (2014)it becomes morally justifiable to withdraw futile mediation when suchinterventions are likely to produce more burdens or harm to patientand relatives. Terminating the medication saves the patient fromunnecessary pain since they will still die even if the medication isoffered. To this end, the quality of life of a dying patient issufficiently low and futile medication cannot make it any better.
Benefitsto the society
Itis more beneficial to the society to terminate futile medication thanto continue with it. For example, the majority of the health carefacilities are experiencing a severe shortage of nurses and otherproviders, which means that allowing patients who have no hope ofrecovering to die will give providers more time to serve the rest ofthe patients (Connect us Fund Organization, 2015). In addition, thecost of care is a critical issue affecting the modern societydirectly and indirectly. This means that the government resourcesand resources from other sources should be used to assist members ofthe society who will eventually recover and contribute towards socialand economic growth of the society. Although the death of a patientreceiving futile medication may cause some distress to members of thesociety, it has a long-term social benefit since people will stopseeing other members of the society writhe in pain.
Thelegal, social, and economic perspectives support the argument thatpatients and members of their families have no right to insist on thecontinuation of futile medication. From the legal perspective, boththe legislations and the court decisions allow health care providersto ignore the opinion of the patient and their legal guardians whenterminating futile medication. From the social perspective, letting apatient who will never recover from a chronic illness die addressesthe issue of doctors and nurse shortage. Basing the argument on theeconomic perspective, hospitals can save millions of dollars annuallyby terminating futile medication. To this end, patients and familiesshould not be allowed to decide whether futile medication will becontinued or not.
Clark,A. (2007). Medical futility: Legal and ethical analysis. VirtualMentor,9 (5), 375-383.
Connectus Fund Organization (2015). Main pros and cons of legalizingphysician assisted suicide. ConnectusfundOrganization.Retrieved December 5, 2015, fromhttp://connectusfund.org/8-main-pros-and-cons-of-legalizing-physician-assisted-suicide
Glen,R. (2015). Futile or fruitful: The Charter and the decision towithhold or withdraw life-sustaining treatment. HealthLaw Journal.Retrieved December 5, 2015, fromhttps://www.questia.com/library/journal/1G1-229302909/futile-or-fruitful-the-charter-and-the-decision-to
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