Chapter 9 :Severely Impaired Newborns and Infanticide
Nancy Jecker and Roberta Pagon: Medical Futility
There are Quantitative considerations, when there is little chance of benefit and Qualitative considerations where the outcome is a poor one. It is an example of INHUMANITY that causes or continues human suffering with no benefit and continues an existence that is not meaningful.
Summary: by Jason Chirichigno (2002)
Jecker and Pagon explore the concept of ethical, medical decision making in regard to hopelessly ill newborns during their treatment in the neo-natal intensive care unit (NICU). They set out to discourage the prevalent notion amongst most neonatologists that all efforts must be taken at all times to save these newborns. "Give the patient the benefit of the doubt, by using all modalities at one's disposal" (Jecker and Pagon, p. 170). They argue that many times this medical mind frame is unethical. Their argument centers around two crucial concepts, that of futility and inhumanity.
For Jecker and Pagon, medical futility, "connotes that such medical efforts are wasteful; even our best efforts can be useless and ineffective" (Jecker and Pagon, p. 170). They argue that there is no ethical or legal imperative to always provide care for "imperiled" infants. Under the heading of medical futility there are two distinct categories; quantitative futility and qualitative futility. Quantitative futility implies that there is only a very small chance that the medical procedure itself will be successful. Qualitative futility states that even if the procedure itself is successful, the quality of life for the patient is not necessarily going to change. Jecker and Pagon pose the example of a medical procedure which keeps a patient alive, yet in a state of unconsciousness, as an example of qualitative futility. The second crucial concept to their argument is that of inhumanity.
An inhumane medical procedure is one that causes suffering with no ultimate benefit for the patient. As a slight caveat of the inhumanity argument is the example of severe trauma where many times the prognosis can be good for the patient if painful procedures can be endured acutely. "As the chance of benefits to the patients increase, the burden of treatment can increase within limits" (Jecker and Pagon, p. 171). In addition to the explanation of inhumane treatments Jecker and Pagon also explore what characteristics are necessary for true human functioning. "These include such qualities as consciousness, intelligent communication of thoughts and feelings, motor activity, and capacities of cognition and recognition" (Jecker and Pagon, p. 171).
The discussion of humanity leads Jecker and Pagon to the concept of medical uncertainty in making these ethical decisions.
The question posed is what role does uncertainty play in medical decision making? For Jecker and Pagon the simplest method to deal with medical uncertainty involves a detailed analysis of the treatment alternatives, along with ranking each according to their worst possible outcomes. This seems simple but how do you define "the worst possible outcome?" Jecker and Pagon propose three possible solutions: 1)collect statistics on the various illnesses, procedures, etc. 2) begin treatment for all infants until no longer medically feasible. 3) begin treatments for all infants until the parents decide that treatment is no longer an option. These three solutions lead to the final section of the Jecker and Pagon article with the discussion of a case study.
The case study involves a seriously impaired infant named Michael, whose prognosis is extremely poor, so the doctors and family decide that it is okay to discontinue medical treatment. Jecker and Pagon close with the final idea that medical practitioners should not engage in futile or inhumane treatments and in cases of medical uncertainty there should be a continued dialog between family and physician, with the ultimate decision in the hands of the family.
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