The Application of Medical Care - Research Paper Example

? Medical Futility: Personal Beliefs al Affiliation Medical Futility: Personal Beliefs People manifest differences in values, beliefsand preferences; depending on the way they have been raised and educated, as well as external factors that influence their behavior. In health care, for instance, the quality and delivery of patient care have been acknowledged to be contingent on the patients’ cultural and religious beliefs and values; as well as personal philosophies in life. The application of medical care and recommended interventions would therefore depend on the most pressing beliefs and practices that have been traditionally followed throughout life. It is in this regard that one hereby presents personal beliefs on the subject of medical futility, especially in end-of-life decisions pertinent to patient care. As required, one is hereby presenting the platform to discuss personal beliefs and to be aptly supported with professional references. Personal Beliefs on End-of Life Decisions and Medical Futility It is my belief that patients near the end of life should be able to die peacefully and comfortably and not to receive aggressive "futile" treatment. In health care, medical futility is actually defined as “the proposed therapy should not be performed because available data show that it will not improve the patient's medical condition” (Bernat, 2005, p. 198). Some studies have asserted that defining when treatment is medically futile remains to be controversial and challenging. As described by McCabe and Storm, disparities in medical associations’ definition of the term seem to add fuel to the controversy, to wit: “The American Medical Association (AMA) guidelines describe medically futile treatments as those having “no reasonable chance of benefiting [the] patient” (American Medical Association, n.d.) but fall short of defining what the word “reasonable” means in this context. The American Thoracic Society says a treatment is medically futile when it is highly unlikely to result in meaningful survival (American Thoracic Society, 1995). The Society for Critical Care Medicine and others say that physicians must be certain that an intervention will fail to accomplish its intended goal before concluding that the intervention would be medically futile (Society of Critical Care Med, 1994)” (McCabe & Storm: When Is a Treatment, 2008, par. 1). The same article contended that there have been several instances when patients and doctors disagree regarding medical futility; especially in end-of-life decisions (McCabe & Storm, 2008). There was a prescribed resolution process that was explicitly noted from AMA. Despite the clear standards and conditions, some patients still allegedly assert that no instance of medical futility could prevent them from instituting continued care until the last breath of their loved ones. As a health care practitioner, one could actually see the rationality of disparities in viewpoints between medical practitioners, especially doctors, and those of the patients and their relatives. End-of-life decisions are almost always difficult to make, especially in cases where there is the recommended need to stop medications, interventions, or the delivery of care due to reasons defined as medically futile. Doctors are merely being professional and their academic background and expertise have contributed to the prescribed decisions to categorize cases as medically futile, if and when necessary. On the contrary, patients and their relatives are attached with strong bonds of love and affection that make it extremely difficult to sever. Depending on cultural or religious practices, traditions, and beliefs, most patients and their relatives belief that it is up to the Supreme Power or Divine Intervention to decide when is the appropriate time to elevant end-of-life matters to fate. One’s personal stance, therefore, is to balance the pros and cons of any decision that involves medically futile treatments, as defined; and the alternative of opting to lengthen access to care using traditional means. If faced in that particular predicament with a loved one as the patient, one would actually seek Divine Intervention and determine the validity of the physician’s recommendation, as well as the access and availability of remaining resources (money, time) and the preference of the patient or loved one. End-of-Life Decisions When conflict between patients and physicians apparently ensue in making end-of-life decisions, especially when the situations were categorized as medically futile, as abovementioned, a seven step process was apparently prescribed by AMA (McCabe & Storm, 2008). Accordingly, “physicians are not obligated, either from a legal or ethical standpoint, to provide care that falls outside of the standard of care” (American Medical Association (AMA), n.d., p. 2.037). As asserted, this guideline included medically futile treatments (McCabe & Storm, 2008). Bernat’s (2005) recommendation to resolve disputes between doctors and patients in medically futile treatments are as follows: “optimize communication between physicians and surrogates; encourage physicians to provide families with accurate, current, and frequent prognostic estimates; assure that physicians address the emotional needs of the family and try to understand the problem from the family's perspective; and facilitate excellent palliative care through the course of the illness” (p. 198). If, despite the recommendation of the physician, the patients’ relatives insist on continuing treatment, and resolution of dispute was deemed impossible, AMA has allegedly recommended that “physicians consult their institution's ethics committee. If the ethics committee supports the physician's position, the patient should be transferred to another physician or institution willing to provide treatment. If transfer is not possible, the intervention need not be offered” (McCabe & Storm: When Doctors and Patients Disagree, 2008, par. 2). In these situations, I honestly believe that it is still the patients and their relatives who has the last say in end-of-life decisions – whether these were defined as medically futile or not; and according to their values and belief systems. My paramount concern and belief is to respect the decision of the patients and their relatives and to ensure that all courtesy and professionalism in the delivery and access to high quality patient care is accorded until these patients are discharged from their jurisdiction. Aside from the ethics committee who provide clear and explicit guidelines and standards in cases of disputes, there are the ethical, moral and legal standards of the profession which define the code of conduct and behavior. Therefore, whatever the decision of the patients in cases such as these, medical practitioners should maintain the highest quality of patient care, as expected and defined by the profession. Conclusion One is convinced that each individual has the prerogative to apply personal preferences and make decisions based on values and beliefs in life. In controversial end-of-life decisions, most rely on the expertise of medical practitioners and physicians to provide the most effective course of action which is deemed appropriate for the patients and loved ones. There are, however, instances when patients and relatives could not simply accept difficult recommendations that exemplify futility in providing additional medical intervention or care due to specifically identified reasons. As such, until contemporary times, despite standards and conditions governing end-of-life decisions and care; as well as providing medically futile treatments, disputes and disagreements still continue to exist. This just proves that end-of-life decisions are challenging decisions to make. One believes that no amount of preparation could effectively confirm the consistency of the decision in an end-of-life scenario. Although, death is believed to be a normal part of life and is just a transition that evidently happens, the difficulty in deciding to terminate all medical interventions possible remain to be imminent. Thus, the best way is still to keep an open mind and to affirm that whatever end-of-life decision that is to be made would be for the ultimate benefit of the patient and for the better welfare of all concerned. References American Medical Association (AMA). (n.d.). AMA Ethics Guideline 2.037: Medical futility in end-of-life care. Retrieved from ama-assn.org: http://www.ama-assn.org/ama/pub/category/2830.html. American Medical Association. (n.d.). Futile care. Retrieved from AMA Ethics Guideline 2.035: http://www.ama-assn.org/ama/pub/category/2830.html. American Thoracic Society. (1995). Withholding and withdrawing life-sustaining therapy. Ann Intern Med, Vol. 115, 478–485. Bernat, J. (2005). Medical futility: definition, determination, and disputes in critical care. Neurocritical care, Vol. 2, Issue 2,198-205. McCabe, M., & Storm, C. (2008). When Doctors and Patients Disagree About Medical Futility. Retrieved from Journal of Oncology Practice: http://jop.ascopubs.org/content/4/4/207.full Society of Critical Care Med. (1994). Consensus statement of the Society of Critical Care Medicine's Ethics Committee regarding futile and other possibly inadvisable treatments. JAMA, Vol. 271,1200–1203. Read More