First, it is important to determine who has the moral and legal right to make medical decisions. The patient has the right to make decisions about his or her own care as long as he or she is mentally capable of doing so. If a patient is deemed mentally incapable of making decisions, a surrogate must be identified. This surrogate mother can be legally assigned by the patient before the incapacity for work (permanent power of attorney) or his next of kin. If there is no way of an identifiable surrogate, the courts must appoint a moral agent who can act in the best interests of the patient. Georgian jurisprudence has developed this definition and introduced a three-part test to support the conclusion that an accused is not guilty of a crime. Insanity can be found when the will is so overwhelming that there is no criminal intent in relation to the act, and it must appear not only that the defendant was actually working under an illusion that acted as a causal factor, but that the illusion was such that, if true, it would justify the act. State, 138 Ga. App. 4, (1976). Modern medicine has made it possible to sustain human life indefinitely.
This has led to difficult legal and moral discussions about medical futility and the transition from aggressive treatment to comfort care. This article emphasized that medical futility must always focus on a discrete clinical outcome. Ongoing patient care is never useless. Negotiating care when the doctor or family believes that treatments are unnecessary is a delicate process based on respect for the values of the patient and the professional. Discrepancies between these values require humility and professional integrity on the part of physicians. Ultimately, respect for people and charitable approaches can lead to ethically and morally viable solutions. Researcher Griffin Trotter presents a clear definition of medical futility3 that is consistent with the concepts of the American Medical Association`s Council on Ethical and Judicial Affairs4 and the Society of Critical Care Medicine Ethics Committee.5 Trotter makes it clear that medical futility occurs when: The legal system is not designed for self-service. Delusional coercion is a difficult defense to prove, and you need a lawyer from Georgia to help you present evidence for that defense. Lawson and Berry and their team of defense attorneys in Georgia have extensive litigation experience, so let their experience work for you. Contact us today for a free case evaluation. Unfortunately, this definition does not provide clear answers to all clinical questions. How can we achieve the “near certainty” that an action will not achieve its goal? There are always exceptions.
There is a tiny, though unlikely, chance that Ms. F. could survive sepsis, become ecstatic, be placed in a nursing home and communicate with her family before succumbing to cancer. In short, delusional compulsion is when someone has a mental disorder that forces them to believe something that, if true, would justify their actions. Ms. F. is a composite patient who comes from several real patients, but this scenario represents a common phenomenon in clinical medicine. Doctors often help families decide when to stop aggressive treatment in favor of supportive care. This period is particularly stressful for doctors in training. As a physician working in our hospital ethics counseling department, I find that more than 80% of our inquiries involve conflicting opinions between health care providers and patients` family members about when to transition to comfort care.
This article provides practical ideas for students, residents and physicians at the beginning of practice regarding how to manage this difficult turning point in clinical medicine. I use the term medical futility to stay in line with the current literature, and I recognize that the term clinical futility is more appropriate for this article. I will explore futility as a concept applied directly to patient care and how physicians negotiate transition decisions when family members and providers have different opinions. Second, physicians should not simply say “no” to patients to futile treatments, but should enter into dialogue and discuss alternatives. If doctors believe that certain treatments are useless, they are always obliged to mention that treatment. Patients and their families have the right to be fully informed and deserve frank explanations of why a particular treatment is not beneficial.9 Indeed, it gives physicians an opportunity to clarify the goals of treatment and shape future discussions. Patients seeking non-traditional treatments should also be respectfully guided in discussions leading to reasonable and harmless medical practice. Physicians have a fiduciary responsibility to inform family members if CPR is considered unnecessary and therefore cannot be performed in good conscience. The patient or surrogate must give permission to write orders for non-resuscitation or discontinuation of aggressive treatments. If these orders are not written, the physician assumes moral complicity in the continuation of aggressive treatments. A common mistake today is that doctors leave this difficult decision to patients without ever briefly expressing their professional opinion that additional aggressive treatment is medically harmful and therefore not indicated. Question 3: When does professional judgment allow physicians to dictate patient care? Insignificance in medicine is an age-old concept.
Hippocrates made it clear that doctors “should refuse to treat those who are overwhelmed by their illness, recognizing that medicine is powerless in such cases.” 1 Webster`s dictionary defines meaninglessly as “serving no useful purpose, totally ineffective.” 2 The word meaningless refers to a specific action, while insignificance is the relationship between an action and a desired goal.
