University of Missouri Hospital and Clinics School Offers Guidance On Withholding Futile Treatments

Health care providers can grapple with the decision to withhold treatments that may be futile for their patients. The ethical decision influencing that decision can be daunting. Assisting patients, or their health care proxies, make these decisions must be made with consideration of several factors. If the patient reaches the point of “biomedical futility” the physician need not administer the treatment. Understanding “biomedical futility” and its implications is vital in making an ethical decision. Physicians and other health care providers can face ethical complaints if the patient or family disagrees with the decision to withhold futile medical treatments. Missouri professional licensing attorney Danielle Sanger has devoted her career to representing licensees such as physicians and other health providers who face potential licensing discipline.

The University of Missouri Hospital and Clinics (“the University”) issued guidelines relating to withholding futile treatments. The University’s directive was based upon the desire to assist physicians and their team in decisions regarding when to “withhold or withdraw” biomedically futile treatments. Biomedical futility is a judgment the physician must make. The University defines biomedical futility as a treatment that cannot meet its goals and is therefore “medically ineffective.” The physician must determine to a “reasonable degree of medical certainty” that the treatment cannot prevent or slow the patient’s decline or cannot prevent impending death of the patient. Those conditions seem obvious. However, a medically ineffective treatment is also one that cannot change the course of a disease in a meaningful way. It is critical to note that a treatment that is medically effective but may diminish the quality of life of the patient is not defined as a biomedically futile treatment.

The University established a procedure for physicians and their health care teams to follow in the event they are faced with making a decision of whether a treatment is medically futile. At the outset, the physician must determine that a treatment is medically ineffective to a reasonable degree of medical certainty. If so, then the physician must discuss treatment goals with the patient and/or the health care proxy. This consultation must include a discussion regarding the medical ineffectiveness of a proposed treatment, the potential or lack thereof for patient improvement, and the burden a given treatment may have upon the patient. Physicians must closely document this procedure in the patient’s medical record.

Once this discussion occurs, then a team meeting must be held. The meeting includes interdisciplinary treatment providers, the patient, the patient’s health care proxy, and the patient’s family. Any decision made during this team meeting must be documented in the patient’s medical record. The patient, their proxy, and staff should be afforded an opportunity to meet with Pastoral Care and/or the Ethics committee in reaching this decision.

At times, the patient and physician may disagree on whether the treatment should be administered. The physician is not required to administer a treatment that is medically ineffective. The physician should advise the patient to seek an alternative opinion. The physician must not abandon the patient if such a disagreement occurs. The physician should arrange for alternate care and take steps to ensure the patient is safe. The physician should consult other health care providers and the ethics committee if the physician determines the treatment must be discontinued. It is also important to note that this decision must be made between the health care providers and the patient. Any opinion offered by a third party of whether the treatment is medically effective must not be considered.

Where To Turn For Help

Missouri Professional Licensing Attorney Danielle Sanger vigorously fights for her clients to protect their livelihood. Attorney Sanger understands that a physician’s decisions can be second guessed, which can lead to facing an ethics complaint. Call Attorney Sanger today at 785-979-4353 to schedule a free consultation and mount your defense today.

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