Chapter 9 :Severely Impaired Newborns and Infanticide


Title: Medical Futility (Commentary)

Author: Norman C. Fost

Publication Information: Reprinted by permission of the publishers from
Ethics and Perinatology, ed. Amnon Goldworth, William Silverman, David
K. Stevenson, Ernle W.D. Young, and Rodney Rivers, pp.72-77. New York:
Oxford University Press. Copyright 1995  


Norman Fost completely disagrees with Jecker and Pagon’s article on
“Medical Futility”. In the article Jecker and Pagon claim that medical
“futility” and “inhumanity” have medical and moral meanings, and we can
use them in treatment decisions. They define futility in two forms –
quantitative and qualitative. They define quantitative medical futility
as a situation when “likelihood of medical benefit” from a treatment is
less than 1:100. Fost questions why a 1:101 is futile and 1:99 is not.
He demands a rationale for settling on such an arbitrary number. Jecker
and Pagon define qualitative medical futility as a situation, when
quality of outcome from a treatment is extremely poor. Fost discards
such definition of qualitative medical futility on the ground that an
outcome is subjective and depends on the personal notion of “what
benefits are worth certain costs”. For some people prolonging a life of
a patient even in an unconscious state, is not futile since for them
life itself has a value.  Jecker and Pagon also suggest that qualitative
futility means when a patient depends on intensive medical care. Fost
considers this definition even more arbitrary as he argues that many
patients in “intensive medical care” find life worth living.


Fost disagrees with the definition of “inhumane” by Jecker and Pagon as
he finds it ambiguous. Fost argues that the “inhumane” patients as
defined by Jecker and Pagon who lack “indicators of human hood” omits
the children with Down syndrome from the class of humans. Fost suggests
that perhaps most people would not want to prolong their life in some
situations, but that does not qualify them as inhumane as suggested by
the duo authors. Fost warns us that the concepts of “futile” and
“inhumane” could be self-fulfilling prophecies. Fost takes an example of
the hospital that in 1960s routinely withheld treatment from infants
that would qualify as futile or inhumane in Jecker and Pagon’s terms.
These infants normally died in this hospital while doctors in other
hospitals were treating similar infants more aggressively. Due to such
practice over the years, today we expect such infants to survive through
aggressive treatment.

Fost takes us back to the era when many Catholic writers argued that if
an intervention was an “extraordinary” mean of treatment; there was no
duty to use it. This argument mainly rose in the course of discussing a
Catholic physician’s duty to use a respirator. Foss argues that in a
secular world, we must answer why it is not a duty to use a treatment
even if it qualifies as “extraordinary”. Fost concludes that the
concepts of “futility” and “inhumane” fail on the same grounds as the
concept of “extraordinary” intervention fails. The duo authors
acknowledge that there is always uncertainty in declaring a situation
futile. Fost in return argues that even in “absolute certain” cases like
a “brain dead” patient, we can prove that we should not consider it
futile. He suggests that there will be choices to make regarding the
continuation of “life” support. The families and doctors might consider
a “brain dead” patient as source of organs and tissues for others. A
living body could also serve many other social purposes such as in
drug-testing, experimenting human physiology, or in manufacturing
antibodies etc. Hence, a “futile” situation is not necessarily futile.
  Summary:  Hita Gurung (QCC,2003)

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