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Refusing and Withdrawing Medical Treatment

Summary

Decisions to withhold or withdraw medical treatment will continue to attract widespread attention in scholarly and public policy discussions. Legal and ethical cases provide the basis for developing standards for settling disputes between patients and families, on the one hand, and the health care team or institution, on the other hand. Increasingly, legal and ethical guidelines support the patient’s right to be left alone while limiting the patient’s right to request specific treatments that run contrary to standards of the health care professions. In law and ethics, patient privacy and autonomy protect the patient’s right to refuse or withdraw treatment. At the same time, legal and ethical support for patients’ requesting futile interventions has generally not been forthcoming.

NANCY S. JECKER

BIBLIOGRAPHY

American College of Chest Surgeons/Society of Critical Care Medicine Consensus Panel. ‘‘Ethical and Moral Guidelines for the Initiation, Continuation and Withdrawal of Intensive Care.’’ Chest 97 (1990): 949.

American Medical Association, Council on Ethical and Judicial Affairs. ‘‘Guidelines for the Appropriate Use of Do-Not-Resuscitate Oders.’’ Journal of the American Medical Association 265 (1991): 1868–1871.

American Medical Association, Council on Ethical and Judicial Affairs, Medical Futility in End of Life Care. Located at http://www.amaassn.org/meetings/public/i96/summary/

American Thoracic Society. ‘‘Withholding and Withdrawing Life-Sustaining Therapy.’’ Annals of Internal Medicine 115 (1991): 478.

ANNAS, G. L. ‘‘Reconciling Quinlan and Saikewicz: Decision Making for the Terminally Ill Incompetent.’’ American Journal of Law and Medicine 4, no. 4 (Winter 1979): 367–396.

CAPRON, A. M. ‘‘Baby Ryan and Virtual Futility.’’ Hastings Center Report (March–April 1995).

GREENHOUSE, L. ‘‘Court Order to Treat Baby Prompts a Debate on Ethics.’’ New York Times, 19 February 1994.

In the Matter of Karen Quinlan: The Complete Legal Briefs, Court Proceedings, and Decisions. Arlington, Va.: University Publications of America, 1975.

JOHNSON, S. H.; GIBBONS, V.; GOLDNER, J. A.; WIENER, R. L.; and ETON, D. ‘‘Legal and Institutional Policy Responses to Medical Futility.’’ Journal of Health and Hospital Law 30, no. 1 (1997).

MILES, S. H. ‘‘Informed Demand for ‘Nonbeneficial’ Medical Treatment.’’ New England Journal of Medicine 325 (1991): 512–515.

QUINLAN, J., and QUINLAN, J., with BATELLE, P. Karen Ann Quinlan. New York: Doubleday, 1977.

SCHNEIDERMAN, L. J., and JECKER, N. S. Wrong Medicine: Doctors, Patients, and Futile Treatment. Baltimore: John Hopkins University Press, 1995.

SCHNEIDERMAN, L. J.; JECKER, N. S.; and JONSEN, A. R. ‘‘Medical Futility: Its Meaning and Ethical Implications.’’ Annals of Internal Medicine 112 (1990): 949–954.

Society for the Right to Die. ‘‘Brophy v. New England Sinai Hospital Inc. Brief Amicus Curiae, Society for the Right to Die, Inc. on Behalf of Appellant.’’ Journal of the American Geriatrics Society 35, no. 7 (July 1987): 669–678.

SOLOMON, M.; O’DONNELL, L.; JENNINGS, B.; GUILFOY, V.; WOLF, S.; NOLAN, K.; JACKSON, R.; KOCH-WESER, D.; and DONNELLEY, S. ‘‘Decisions Near the End of Life: Professional Views on Life-Sustaining Treatment.’’ American Journal of Public Health 83, no. 1 (1993): 14–23.

CASES

Bryan v. Rectors and Visitors of the University of Virginia, 95 F. 3d 349 (4th Circuit, 1996).

Cruzan v. Director, Missouri Department of Health, 110 S. Ct. 2841 (1990).

Gilgunn v. Massachusetts General Hospital, no. 92-4820 (Mass. Super. Ct., Suffolk County, 21 April 1995). Reported in Gina Kolata, ‘‘Withholding Care from Patients: Boston Case Asks, Who Decides?’’ New York Times, 3 April 1995, p. A1.

In re Baby K, 832 F. Supp. 1022 (E.D. Va. 1993), aff’d, 16 F.3d 590 (4th Cir. 1994).

Additional topics

Medicine EncyclopediaAging Healthy - Part 4Refusing and Withdrawing Medical Treatment - Historical Background, The Ethics Of Refusing And Withdrawing Treatment, Summary