Analyzing "Is it Always Wrong to Provide Futile Care?"

Rosemary Flanigan

March 3, 2010

Robert Truog's "Is it always wrong to provide futile care?" in the February 11th New England Journal of Medicine prompted some excellent discussion at the Center for Practical Bioethics.

(Link: Murky path on deciding care at the end, New York Times, Feb 22)

Although "always" and "never" questions allow wriggle room, I spent time wondering how an ethical analysis helped here.

It is easy to set up the analysis; from moral principles one can see the conflict between beneficence and nonmaleficence. The arguments for the priority of nonmaleficence in this case simply flows off the tongue. Or, if you are arguing in a utilitarian framework, it is simple to show the strength of the consequences of non-intervention on the ultimate outcome.

But here, argument doesn't convince. I can see Dr. Truog even agreeing that your argument is stronger than his, yet he justifies acting as he did. So what is the point of argument?

Ethics committee members make compelling arguments in case consultations that are often rejected by patients, families or providers.

WHY OUGHT WE KEEP DOING IT? HELP!!!

When to perform futile CPR

Rosemary Flanigan

March 2, 2010

In the Feb. 11th New England Journal of Medicine Robert Truog, MD (who seems to write as often as Atul Gawande) justifies performing futile CPR for the benefit of family members—not often, of course, and never when it would cause substantial suffering or the withdrawal of resources from others would be a credible threat—but sometimes—and in instances where no “practice guidelines” might ever catch—as an act of sincere caring and compassion.

I think most professionals of all sorts can look back on their lives and “justify” futile actions that they would repeat, given the same circumstances. It makes finger pointing and eyes-to-heaven looks rather silly.

But then to Dr. Truog I’d say: “But not too often, I hope.”

Good reflection. Life just isn’t so simple!