Authority, futility, and clinical treatment: The challenge to authority.

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Title: Authority, futility, and clinical treatment: The challenge to authority.
Authors: Christie, Timothy.
Date: 1999
Abstract: The doctrine of informed consent established a distinctive role for both the doctor and the patient, in the doctor-patient relationship. This doctrine, represented by the compound word "informed consent" placed a duty on the physician to "inform" and gave a specific task to the patient "consent." The physician was required to inform the patient to the extent that a reasonable person in that situation would want to be informed. Then the patient had the prerogative of whether to consent or refuse to consent. However, during the late 1980's and early 1900's different clinical situations arose which could not be accommodated by simply giving patients the right to consent or refuse to consent. Situations developed in which health care professionals wanted to refuse to provide treatment on the grounds that further treatment is medically futile and patients' (and/or their families) wanted to insist on treatment claiming that it was not futile and that it served a genuine purpose. Essentially, the informed consent doctrine provided patients with the "negative right" to refuse treatment. The idea of medical futility revealed the limitations of informed consent by demonstrating that some patients also wanted a "positive right" to demand treatment. After analysing this new phenomenon it appears that it is the most recent manifestation of the age-old debate between professional paternalism and patient autonomy. As a result, this thesis analyses the futility debate and then takes a step back in order to evaluate it from the more general perspective of establishing the legitimate domains of both patient and professional authority. Standard approaches to the futility debate generally argue for unilateral decision making authority for either the patient or professional, concerning futility issues. However, the problem with this approach is that it renders the doctor-patient relationship as a zero-sum game; in other words, if one side wins the other side loses. Alternatively, the focus of this thesis is to propose a model of professional and patient authority which allows each party substantial decision-making authority but is also mutually supportive. Therefore, this new approach to the futility debate, and indeed the doctor-patient relationship in general, is undertaken with the intention of preventing these types of disputes from arising, rather than attempting to resolve the conflict once it is fully developed.
URL: http://hdl.handle.net/10393/8915
http://dx.doi.org/10.20381/ruor-16048
CollectionTh├Ęses, 1910 - 2010 // Theses, 1910 - 2010
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