Miljeteig Ingrid, Johansson Kjell Arne, Norheim Ole Frithjof
Fagområdet medisinsk etikk, Institutt for samfunnsmedisinske fag, Universitetet i Bergen, Postboks 7804, 5020 Bergen.
Tidsskr Nor Laegeforen. 2008 Oct 9;128(19):2185-9.
The concept "medical futile treatment" is disputed and is not unequivocally defined. The paper explores legitimate disagreement, autonomy and decision making processes in two cases concerning withdrawal of treatment. We suggest a decision making procedure for such cases.
A case study of two dilemmas discussed in Norwegian mass media: a four-year-old girl with severe brain damage and a ten-year-old girl with leukaemia. Sources are public documents, newspaper articles and scientific papers. The framework used to evaluate the cases is based on ethics theory and a procedural framework originally developed for priority setting in healthcare.
Both cases illustrate disagreement between health personnel and relatives. What seemed to be a medical disagreement turned out to be a conflict where the parties valued the expected outcomes from treatment differently. The doctors found the treatment to be futile in both cases, while the parents disagreed. The conflict was not solved by giving the parents decisive influence in the decision making process. The decision making process did not adhere to standard requirements for due processes.
Decisions on withdrawal of treatment should not be made by the doctors alone. Such decisions entail choices between values where there may be legitimate disagreement between affected parties. In unsolved conflicts the case should be handed to a clinical ethics committee or another independent board to ensure legitimacy and trust in the decision making process.
