PT  - JOURNAL ARTICLE
AU  - C. Weijer
AU  - P. A. Singer
AU  - B. M. Dickens
AU  - S. Workman
TI  - Bioethics for clinicians: 16. Dealing with demands for inappropriate treatment
DP  - 1998 Oct 06
TA  - Canadian Medical Association Journal
PG  - 817--821
VI  - 159
IP  - 7
4099  - http://www.cmaj.ca/content/159/7/817.short
4100  - http://www.cmaj.ca/content/159/7/817.full
SO  - CMAJ1998 Oct 06; 159
AB  - Demands by Patients or their Families for treatment thought to be inappropriate by health care providers constitute an important set of moral problems in clinical practice. A variety of approaches to such cases have been described in the literature, including medical futility, standard of care and negotiation. Medical futility fails because it confounds morally distinct cases: demand for an ineffective treatment and demand for an effective treatment that supports a controversial end (e.g., permanent unconsciousness). Medical futility is not necessary in the first case and is harmful in the second. Ineffective treatment falls outside the standard of care, and thus health care workers have no obligation to provide it. Demands for treatment that supports controversial ends are difficult cases best addressed through open communication, negotiation and the use of conflict-resolution techniques. Institutions should ensure that fair and unambiguous procedures for dealing with such cases are laid out in policy statements.