Med prof helps formulate ethics statement

Is it ethical for a doctor to turn down a patient's request for life-sustaining treatment if the doctor believes the treatment would be futile? According to a new statement from the American Thoracic Society, the medical division of the American Lung Association, the answer is yes. According to the new ATS guidelines, prepared in part by a Medical School professor, a physician has no ethical obligation to administer treatment "if reasoning and experience indicate that the intervention would be highly unlikely to result in a meaningful survival for the patient." According to Susan Rappaport, manager of epidemiology and statistics at ATS, the guidelines were based on a recent ATS survey indicating that 83 percent of physicians surveyed have at some point written "Do Not Resuscitate" on a patient's chart on the basis that treatment would be medically futile. According to the same survey, 10.5 percent of respondents said that their hospital has a written policy which covers medical futility while 61.4 percent said that their institution did not. The statement, "Withholding and Withdrawing Life-Sustaining Therapy," appears in the September "American Review of Respiratory Disease," and also has been published in the September 15 "Annals of Internal Medicine." Lanken said guidelines were needed to help physicians to make life-and-death decisions. He cites a survey of ATS physicians in which 88 percent of respondents said they had withdrawn life-support from a patient within the last year. "Discussion of these issues is an essential part of good medical care," said Lanken. The ATS statement also includes sections on the patient's right to refuse treatment and the role of surrogate decision-making. The statement says, "An adult patient who has decision-making capacity and is appropriately informed, has the right to forego . . . life-saving therapy." If such a course is chosen, the physician is said to be responsible to administer painkillers "even if the patient's death may be unintentionally hastened in the process." If a patient no longer has decision-making capacity, a surrogate may be appointed to exercise the patient's rights and "to make the same decisions as the patient would have made if capable of doing so." If the surrogate's decision seems to go against the patient's preferences, the physician has the ethical obligation to follow the patient's wishes instead. "Someone has to take responsibility for what's going on even if the family threatens to sue for withholding treatment," said Lanken. Lanken said that the guidelines were based on the HUP policy statement which he wrote in February 1990. The ATS Bioethics Task Force held several meetings and workshops before formulating the final draft for the new nationwide policy. Lanken emphasized the importance of open communication between patient and physician. "Clear communication is the best way to avoid conflicts and to ensure that the patient's wishes are carried out," he said. Lanken said physicians should receive bioethics information early in their training. "We'll have to start at the Med School to integrate the system into the mindset of the physician," he said.