Futile Care Theory: A Threat To Life

You may never have heard of Futile Care Theory but it is real and is a potential threat to the life of every person. Futile Care Theory (FTC) is a theoretical construct proclaiming the right of doctors and healthcare authorities to refuse to provide wanted and needed care based on their subjective views of the quality of patient's lives. FTC justifies the refusal of desired medical treatment in hospitals and nursing homes to patients who are dying or disabled. It is a policy authorizing doctors to terminate wanted life-extending medical treatment over the objections of the family and patient when the doctors believe that the patient's life is not worth living.

According to the theory, when a patient reaches a certain age, stage of illness, or severity of injury any further treatment other than comfort care is futile and should be withheld or withdrawn. That the patient may want treatment because of deeply held values or a desire to live longer is neither important nor decisive. The doctors and hospitals involved have the right to refuse treatment.

So, what treatments qualify as futile? Bioethicists and the medical community continue to debate the answer to this question. However, the fact that it is debatable should raise a red flag. Not long ago medical futility was an objective medical determination that a treatment would have virtually no physiological benefit to the patient. Under FTC, this has become a value judgment and not a medical determination. We need to be aware that those who support the theory use terms like "medical futility," "inappropriate care," or "non-beneficial treatment," to cloak their subjective value judgments.

FTC brings with it numerous opportunities for abuse:

• Physician paternalism: depriving the patient of autonomy; shaming the family to listen to the "doctor who knows best."
  
• Medical decisions based on prejudices or bias against certain groups of people: racial, disabled, etc.
  
• FTC gives some of medicine's most important health care decisions to strangers.
  
• In the place of family decision-making, the trend is toward hospital medical ethics committees making life and death decisions.
  
• Proponents view FTC as a money-saving measure in these days of concern over rising health care costs.
  

Is FTC really being implemented? The short answer is yes! Some doctors and hospitals are already refusing care based on FTC. Texas has a futile care law on the books. FTC legislation has been proposed in Idaho and other states. FTC has found acceptance in the courts (but not uniformly). In addition, groups across the country continue to lobby for futile care legislation.

Is FTC theory a real threat? Decide for yourself:

• In England, where the socialized medical system is financially strained, decisions are being made to reject patients for life-extending treatment based on value judgments regarding the patient's overall quality of life.
  

 

• Recently, the State of Oregon refused to approve a person's Medicaid funded treatment for cancer, a treatment that could extend her life. Yet Medicaid would pay for her assisted suicide!
  

 

• In a recently published book, In Defiance of Death: Exposing the Real Costs of End of Life Care, the authors make a proposal to establish a system of "appropriate-care committees made up of experienced physicians who would review each case on an individual basis. Local, state and national committees would be organized hierarchically with each lower level answerable to the level above. Committees would have the authority to withhold payment for care deemed inappropriate."
  

 

Clearly, Futile Care Theory is a threat to life and must be opposed by all who recognize the sanctity of life create in the image of God.