FUTILE CARE: Who Decides?

      An opinion piece in Wednesday's San Jose Mercury News commends El Camino Hospital for instituting a "futile care" policy and outlines the bioethics of such issues. Dr. Michael Siegel, a member of the California Medical Association Council on Ethical Affairs and chair of the Bioethics Committee of Mills-Peninsula Hospital, asks, "Who decides?" the proper intensity and scope of end-of-life care. He writes that modern medical ethics "rests on four cornerstones": the patient's autonomy of choice, the dual obligations of beneficence and non-maleficence of health professionals and the concept of distributive justice, which gives every member of society "his due." He presents futile care as a conflict between the pillars of autonomy and beneficence/non-maleficence, lamenting that in the past 25 years, autonomy has prevailed. Siegel says this is because patients have been empowered to make decisions on the matter, and individual physicians are not in a position to undermine this decision. He also dismisses the practical usefulness of ethics committees or of informing a patient that he or she will be responsible for continuing costs beyond a certain point, since many patients at county hospitals are poor or destitute. He says patients must be educated that their situation is often not a choice of "cure or quick, painless death." Rather, they often face "months of intensive care, dependence on machines, and repeated hospital admissions." He concludes that we owe the suspension of futile care to other patients with treatable conditions, to whom resources may be more effectively devoted (6/17).