And esteemed Medical Ethicist gives them a mild rebuke.
Somehow, this professor has not seemed to notice the change in delivery of medical care in our country-- not since the passing of the Affordable Healthcare Act two years ago, but of Medicare in 1965.
He starts by describing a study:
Medscape just conducted a survey of 24,000 doctors, and only 25% said they would not provide futile interventions. A very significant percentage, more than 30%, said that they would. The rest of those surveyed said they might, depending on the circumstances. That is a startling finding because the way we understand futility in ethics and in medical practice is "no benefit." So why would you do things that don't benefit the patient?Professor Caplan, came down on the right position, against the majority of doctors who said that they would, in fact, continue treatment that is futile, meaning will not extend life or comfort of the dying patient. What he avoids is any sense of outrage, of contempt for a profession that abides by this practice, and tries to explain why they are wrong, as if they were rather dull children instead of seasoned educated professional who have an obvious, but unstated, reason to continue treatment until the last painful breath of the comatose person has ceased.
The obvious reason, once every medical explanation is refuted, is that doctors and hospitals make a ton of money on them, and because they are terminal and will not be in a position to complain, never cause any trouble.
He even refutes the main excuse here:
The fact that a lot of doctors are still willing to give futile care is probably tied in with another reality, and that is fear about the law. People worry that "if somebody sues me, and I didn't do x, y, or z, then I'm going to be on the wrong end of a malpractice suit."Prof. Caplan's ethical schemata would be perfectly appropriate in the absence of any public funding for medical care, such as where the funds for such treatment, as currently is the case, for instance, for cryogenic preservation, is between the individual and the supplier. If anyone chooses to have their body preserved in the hope of eventual revival, there are no public funds, taxpayer wealth extraction, that will be diverted for their individual expenditure. The only ethical question in this case is between provider and patient.
I have never seen it. I have acted as an expert witness. You don't lose those cases. If you say in good conscience, as a physician, as an expert, that I believed that doing something was futile and I didn't do it, and I talked about that with the patient -- anybody can sue you at any time for anything -- you are not going to lose that case because you are following the standard of care and what you believe to be true as the expert.
Using futile care as a way to stave off or avoid malpractice suits or litigation is not good for the patient, and in these kinds of situations, you want to do what is best for the patient. Prolonging suffering, causing the patient more harm -- if that is part of what futility means, to have a false sense of security about a lawsuit -- is not the way to go.
Prof. Caplan describes the situation with end of life medical care in this matter at least a half dozen times in this short presentation. There is not the least hint that those in this terminal condition are almost universally being financed by public funding such as Medicare. There is not the least acknowledgement of this fiscal expense that is growing at an unsustainable rate, that came within a hair's breadth of being curtailed days ago, and still faces reduction.
The decision to extend futile care of the suffering terminally ill, which in itself is ethically abhorrent, is more than compounded by the not arcane fiscal reality, namely that scarce resources expended for hopeless treatment will mean denial of medical services that could provide actual ease of suffering and extension of life.
What this video demonstrates goes beyond one individual's failings, but that his universal acclaim within the medical-academic community shows the depth of its deep immorality. It demonstrates how difficult, but how necessary, it is to wrest control of delivery of medical care from a corrupted profession.
Those physicians, including researcher writer Eric Topol, represent the 25% who gave the ethical response are saluted. . Thihs detailed comment by a physician to this essay gives his personal explanation why doctors do futile treatment.
I have grave doubts that President Obama,or anyone currently in political life has the capacity to engage the majority, those who award the prestigious positions in bioethics to those who challenge their depredations with barely a whisper. This systemic waste by futile treatment ultimately results in the death of innocents, and eventually must lead to the failure of this mechanism of social responsibility that we refer to as Obamacare.