Some good passages from Patients and Doctors — The Evolution of a Relationship, by Robert D. Truog:
Physicians are seen as having expertise and authority over matters of medical science, whereas patients hold sway over questions of values or preferences.
This division of labor reflects a recognition of the naturalistic fallacy, the erroneous notion that one can derive ethical conclusions from scientific facts; in truth, an “ought” cannot be deduced from an “is.” […]
[Yet,] strong disagreement persists about patients’ rights to demand care that physicians regard as medically inappropriate. […]
In recent years, the Texas Advance Directives Act has defined one very concrete approach to addressing these dilemmas. When families demand treatments that have an exceedingly low likelihood of success or that sustain life of such low quality that one might reasonably say it is of no benefit to the patient, Texas law allows physicians to refuse to provide such treatments. Under the Texas legislation, demands by families for treatments that appear to meet these criteria are adjudicated by a hospital-based committee, and if the committee agrees with the clinicians, and if other providers cannot be located who are willing to provide such care, then treatment may be withdrawn without the permission of the patient’s surrogate. Although Texas has the most experience with this approach, other states are showing interest in similar proposals that address both the financial implications of providing allegedly inappropriate care and the concerns of clinicians who must endure the moral burdens and burnout associated with being compelled to provide treatments they believe are ethically wrong.
I don’t take this “moral burden and burnout” lightly. I imagine it is extremely hard to provide care one feels is of little benefit. Does Texas have the right idea?
AF
