Incoming patients with severe brain damage should not routinely be given aggressive medical treatment at the Hospital of the University of Pennsylvania, according to a policy recommendation from the hospital ethics committee.
The new guidelines, which were approved by the committee, state that high-tech measures may not be taken to care for patients in a vegetative or minimally conscious state.
Arthur Caplan, director of Penn's Center for Bioethics, said the guidelines were made to be sensible, not as a method of saving money or manpower.
"This is not a policy to avoid caring for people who are terminally ill, and it has nothing to do with reducing cost or making more beds available for patients," he said. "It's saying it's hopeless to provide treatment in such circumstances."
Caplan said the policy mirrors public opinion -- 95 percent of people say they would not want to be kept alive if they were in a vegetative state.
But Thomas Jefferson University Hospital Ethics Committee Chairman Robert Perkel said that less than 25 percent of people have a living will or advanced directive which states that wish.
The policy change will take effect in a year and is contingent upon approval by the Hospital Board of Trustees. The guidelines will not affect any of the hospital's current patients.
If it is approved, doctors will still have to comply with family members' wishes in such cases, as well as a patient's living will when applicable.
And HUP doctors will still work to prevent patients from suffering and discomfort.
Director of the American Medical Association Ethics Department Karine Morin said the Council on Judicial and Ethical Affairs encourages hospitals to establish guidelines for end-of-life treatment.
She said that one danger of implementing the policy, however, is that family members may harbor "suspicions as to physician's ulterior motives."
But "HUP makes it clear in advance why it's doing this, that sustaining life provides no medical benefit," Morin said. "Families can understand the clear and good intent of medical providers."
Caplan admits that initially the policy will be an adjustment, but in time will be respected by both patients and family.
"It's always controversial to say you are not going to treat someone, even if it's futile," he said. "But if people clearly understand circumstances, it's hard to imagine there would be a whole lot of controversy about it."
Caplan said the policy makes sense but "is kind of unusual because most hospitals don't have these policies."
He thinks most hospitals will follow suit, though.
The ethics committee thought "about the reasonable thing to do when faced with a tragic situation," he added.
Morin applauded the committee -- she said it has managed to clearly explain its policy and dispel questions regarding its reasoning.
"HUP has established a process and communicated it to the community," Morin said.
"So hopefully people can come seek medical care from HUP knowing where the hospital stands in terms of end of life policy," she added. "That transparency is very important when it comes to decisions at the end of life."
HUP officials did not return phone calls for comment.
