Reason-Giving and Medical Futility: Contrasting Legal and Social Discourse in the United States With the United Kingdom and Ontario, Canada.
Disputes regarding life-prolonging treatments are stressful for all parties involved. These disagreements are appropriately almost always resolved with intensive communication and negotiation. Those rare cases that are not require a resolution process that ensures fairness and due process. We describe three recent cases from different countries (the United States, United Kingdom, and Ontario, Canada) to qualitatively contrast the legal responses to intractable, policy-level disputes regarding end-of-life care in each of these countries. In so doing, we define the continuum of clinical and social utility among different types of dispute resolution processes and emphasize the importance of public reason-giving in the societal discussion regarding policy-level solutions to end-of-life treatment disputes. We argue that precedential, publicly available, written rulings for these decisions most effectively help to move the social debate forward in a way that is beneficial to clinicians, patients, and citizens. This analysis highlights the lack of such rulings within the United States.
Indiana University Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Indianapolis, IN; Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health Methodist Hospital, Indianapolis, IN. Electronic address: gbosslet@iu.edu.
Gabriel T
GT
Bosslet
Indiana University Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Indianapolis, IN; Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health Methodist Hospital, Indianapolis, IN.
Mary
M
Baker
Mitchell Hamline School of Law, St Paul, MN.
Thaddeus M
TM
Pope
D016223:Advance Directives; D034462:Dissent and Disputes / Q000331:legislation & jurisprudence*; D028741:Ethics Committees, Clinical; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D007603:Jurisprudence; D008020:Life Support Care / Q000941:ethics / Q000331:legislation & jurisprudence*; D018447:Medical Futility / Q000941:ethics / Q000331:legislation & jurisprudence*; D009864:Ontario; D013222:State Medicine; D013727:Terminal Care / Q000941:ethics / Q000331:legislation & jurisprudence*; D013781:Texas; D006113:United Kingdom; D014481:United States; D028761:Withholding Treatment / Q000941:ethics / Q000331:legislation & jurisprudence*
end-of-life; ethics; law