This is part of a press release that I received about a medical ethics conference being held at Seattle Children’s Hospital. Medical ethics has becoming an increasingly sticky point in healthcare, and you just can’t ignore the issues if you are working in an acute care environment. One of the stickiest issues has to do with critically ill kids, and who makes the the decisions regarding treatment.

Parents Request “Futile” Treatments

What are the limits of medical intervention? When should treatment be considered “futile”? The majority of the medical community agrees that care is futile when it does not achieve its purpose. But medical ethicist Dr. Norman Fost, professor of pediatrics and bioethics, University of Wisconsin, cautioned that there is no definitive definition of futile treatments.

“The fact that a treatment hasn’t been tried or hasn’t been successful in the past does not mean it will not be successful in the future,” said Fost. “Some medical professionals deem any treatment that has not worked in 100 cases is not viable. Many parents argue a one in 10,000 chance still isn’t zero.”

To determine whether a treatment is futile, ethicists argue that we must look at whether the patient is gaining anything from the treatment. If life-saving actions are taken for a child whose quality of life will be poor, who does that serve? Fost reminds us that these are personal value judgments and not medical judgments. This is why, in part, the medical community cannot agree on a specific definition for futility in medical treatments. The search for an ultimate definition of futility is futile, Fost argues.

Can Physicians Refuse to Provide Life-Prolonging Medical Interventions?

The father of a child with severe neurological damage asks for a treatment that the medical community agrees will not work. In fact, it may put the child at even higher risk. But the father goes to the media and the court; the court orders the hospital to give the treatment a try. Since no U.S. court has ever refused life-sustaining treatment without parental consent, should hospitals save the court costs and just abide by whatever the parents request, for as long as they request it?” asked John J. Paris, SJ, PhD, professor of bioethics, Boston College. “Is that responsible medical care?”

“We are all going to die,” said Rev. Paris. “So what is the best way to treat a dying child – and who decides?” Paris suggested that treatment must be in the best interest of the patient. So, if technology can prevent death, but it cannot restore well-being, what is the benefit? Balancing the benefit and burden of medical intervention is the job of everyone involved in the care of the patient.