Bioethics Blogs

Potentially Inappropriate Overtreatment – Surrogate-Driven or Clinician-Driven?

In a recent letter to the New York Times, physician and ethicist Kenneth Prager observes:

“In the vast majority of cases of patients in my hospital who have lingered in I.C.U.s with no chance of recovery, 
it has been the families of patients who have insisted on futile, invasive treatment, not the doctors. In fact, New York State does not give legal protection to physicians who would unilaterally withhold or withdraw life support from such patients, and so their suffering may be prolonged for weeks or months.”

I agree that New York limits the ability of physicians to resist surrogate demands in intractable conflicts.   Accordingly, I have described New York as a “red light” state.

But I wonder whether the problem of surrogate-driven over-treatment is really bigger than the problem of clinician-driven over-treatment.  Perhaps it is in the ICU.  But in medicine in general (e.g. in the oncology clinic, in the cardiology clinic), 
clinician-driven over-treatment is the bigger problem.

But let’s get back to the ICU.  Even New York clinicians are not blameless.  Surrogates may ask for interventions that clinicians deem non-beneficial, potentially inappropriate, disproportionate, or futile.  Rarely do clinicians need to resort to the force of law to resist such demands.  Continued discussion, mediation, and remonstration with the surrogate is almost always sufficient.  Yet, many clinicians cave-in and do not undertake the hard work of reaching consensus and agreement.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.