For example, withholding treatment from patients because you are afraid you will be sued is unethical. So is failing to report medical negligence. Similarly, offering a patient a discount on services they cannot afford is wrong.
Full Answer
Is withholding or withdrawing therapy ethical?
· Abstract. A general rationale is presented for withholding and withdrawing medical treatment in end-of-life situations, and an argument is offered for the moral irrelevance of the distinction, both in the context of pharmaceutical treatments, such as chemotherapy in cancer, and in the context of life-sustaining treatments, such as the ...
Why would a doctor withhold treatment?
· An ethical distinction is drawn between acts and omissions. How this distinction relates to withdrawing and withholding treatment will be considered. Further ethical issues discussed relate to judgements about the futility of treatment, patient autonomy and nurses' duty of care to patients at the end of life. Publication types Review
What are the laws about withholding or withdrawing life-sustaining treatments?
· Some physicians may find it unethical to withhold or withdraw these interventions; however, strong legal support is in place for thoughtful withholding or withdrawal of fluids and nutrition at the...
Is withdrawal or withholding of treatment equivalent to euthanasia?
In some cases though, ethical questions about withholding treatment pertain most saliently to the issue of from whom we are withholding medical treatment. Triage systems are decision protocols for allocating scarce medical resources in scenarios where need outstrips available resources; since all cannot be treated, then we need principles to determine who of the many in …
Is withholding treatment unethical?
Code of Medical Ethics Opinion 5.3 While there may be an emotional difference between not initiating an intervention at all and discontinuing it later in the course of care, there is no ethical difference between withholding and withdrawing treatment.
Is withholding information ethical?
Except in emergency situations in which a patient is incapable of making an informed decision, withholding information without the patient's knowledge or consent is ethically unacceptable.
What does withholding treatment mean?
(5) the term “withholding of medically indicated treatment” means the failure to respond to the infant's life-threatening conditions by providing treatment (including appropriate nutrition, hydration, and medication) which, in the treating physician's or physicians' reasonable medical judgment, will be most likely to ...
Is withholding medical treatment legal?
There is no legal basis for physicians who act sensitively and responsibly in the withholding or withdrawal of treatment to fear conviction under criminal law.
What is it called when someone withholds information?
When we deliberately withhold or conceal information from each other, we are doing something called “knowledge hiding,” an action that can take several different forms.
What does it mean to withhold information deliberately?
The meaning of the verb is "be deliberately ambiguous or unclear in order to mislead or withhold information".
Is withholding medication a crime?
Deliberate negligence This involves a caretaker or family member deliberately choosing not to provide medication to the elderly individual. Even if the first few times were accidental, refusing to correct the issue can lead to any potential criminal charges being upgraded from negligent to deliberate.
Is withholding medication abusive?
Medication abuse includes inappropriate use of medications (e.g., overuse of sedatives) or withholding prescribed medications.
How is withholding treatment different from withdrawing treatment?
Such decisions can essentially take one of two forms: withdrawing – the removal of a therapy that has been started in an attempt to sustain life but is not, or is no longer, effective – and withholding – the decision not to make further therapeutic interventions.
Who makes decisions regarding withholding or withdrawing treatment?
The patient or decision maker, after being provided appropriate counseling and options, decides against this intervention to reflect personal values. Information from Education for Physicians on End-of-Life Care Trainer's Guide, Module 11, withholding, withdrawing therapy.
Do patients have the right to refuse life sustaining treatment?
Under federal law, the Patient Self-Determination Act (PSDA) guarantees the right to refuse life sustaining treatment at the end of life.
What is termination of life sustaining treatment?
When is it justifiable to discontinue life-sustaining treatments? If the patient has the ability to make decisions, fully understands the consequences of their decision, and states they no longer want a treatment, it is justifiable to withdraw the treatment.
When should a physician elicit patient goals of care?
Physicians should elicit patient goals of care and preferences regarding life-sustaining interventions early in the course of care, including the patient’s surrogate in that discussion whenever possible.
Is it ethical to withhold life sustaining interventions?
Decisions to withhold or withdraw life-sustaining interventions can be ethically and emotionally challenging to all involved. However, a patient who has decision-making capacity appropriate to the decision at hand has the right to decline any medical intervention or ask that an intervention be stopped, even when that decision is expected to lead ...
Is there an ethical difference between withholding and withdrawing treatment?
While there may be an emotional difference between not initiating an intervention at all and discontinuing it later in the course of care, there is no ethical difference between withholding and withdrawing treatment.
Who decides against an intervention?
The patient or decision maker, after being provided appropriate counseling and options, decides against this intervention to reflect personal values.
Is it ethical to withhold life-sustaining therapy?
Withholding or withdrawing life-sustaining therapies is ethical and medically appropriate in some circumstances. This article summarizes the American Medical Association's Education for Physicians on End-of-life Care (EPEC) curriculum module on withholding or withdrawing therapy. Before reviewing specific treatment preferences, it is useful to ask patients about their understanding of the illness and to discuss their values and general goals of care. Family physicians should feel free to provide specific advice to patients and families struggling with these decisions. Patients with decision-making capacity can opt to forego any medical intervention, including artificial nutrition/hydration and cardiopulmonary resuscitation.
Is the intent of the medication to cause death important?
No. The intent and sequence of actions are important, as are the means chosen. If the intent is to secure comfort, not death; if the medications are chosen for and titrated to the patient's symptoms; if the medications are not administered with the primary intent to cause death, then ventilator withdrawal and pain treatment are not euthanasia.
Is euthanasia a decision to seek death?
No. There is a strong general consensus that withdrawal or withholding of treatment is a decision that allows the disease to progress on its natural course. It is not a decision to seek death and end life.Euthanasia actively seeks to end the patient's life.
Can you refuse medical treatment?
No. To the contrary, patients have a right to refuse any medical treatment , even life-sustaining treatments such as mechanical ventilation, or even artificial hydration and nutrition.
Is artificial nutrition and hydration misperceived as neglect?
References. Physicians have difficulty with the decision to initiate or continue artificial nutrition and/or hydration. Food and water are symbols of caring, so withholding artificial nutrition and hydration may be misperceived as neglect.
Why would a doctor withhold treatment?
Sometimes a doctor may wish to withhold treatment because although the patient thinks he or she is ill, the doctor doesn't agree and believes that any treatment could be harmful. On occasions, friends or family of a patient may ask for treatment out of misunderstanding or fear.
What is the purpose of medical treatment?
A medical treatment can have two basic functions. First it can aim to cure the person . This is the sort of treatment that we hope to receive when we visit our GP. Our desire is to go in, describe the problem, have a few tests and come away with the treatment that solves it.
When a road accident victim arrives in a casualty department, staff have to work fast?
When a road accident victim arrives in a casualty department, staff have to work fast, but they must also assess whether it is appropriate to commence extreme measures to maintain the patient's life, or whether intervention is inappropriate.
Why is it important to cure?
To an extent, curing is about warding off death, because if illness is not stopped then a person may die. You could say that curing helps people to have a good quantity of life.
What are the ethical principles of medical care?
The British Medical Association's Medical Ethics Committee recently published a consultation paper asking for people's views on all aspects of withdrawing or withholding life-prolonging medical treatment. The Christian Medical Fellowship's response included the following ten-point guide to underlying principles: 1 Intentional killing is always unnecessary and wrong 2 Life has a natural end and there is not necessarily anyone to blame when a patient dies 3 Doctors tend to over-treat towards the end of life, causing demand for euthanasia 4 Society needs to break its current taboo about facing death 5 Considering the Christian faith is essential for a healthy exploration of the concept of death 6 When accepting that cure is either not possible or not sought by the patient, care continues 7 The most senior clinicians should be central figures in these ethical decisions 8 Many of the difficult decisions are more 'clinical' than 'ethical' 9 Medicine is a biological science with uncertain outcomes but research must improve its evidence base 10 Principles for guidance which define ethical boundaries are more helpful than prescriptive guidelines
Is it ethical to withdraw a treatment?
At the same time a decision to withdraw a treatment is often seen as more ethically complex than not starting the treatment in the first place. While stopping a treatment may be more traumatic for the patient or relatives, in fact, decisions for both actions are normally a basic part of good medical practice.
What ethical principle is used to withdraw and withhold?
Dominant Western ethical opinion concerning withdraw and withhold decisions is based in a moral equivalence thesis [ 12 ]; if there is no moral difference between withdrawing and withholding, then (all else being equal) there is no instance in which it would be allowable to withhold a treatment but not to discontinue the same treatment once it is started. Subjecting hopelessly ill patients to therapy that is unlikely to be beneficial potentially violates at least two basic principles of Western medical ethics: beneficence (doing good) and nonmaleficence (avoiding harm) [ 13, 14 ]. Furthermore, if physicians cannot ethically withdraw LSTs once they are started, then they may be less willing to initiate treatments that have only a small potential for benefit out of concern that the patient may become trapped into therapy that cannot be discontinued if burdens turn out later to be too great [ 15 ]. Such trial therapy is an important strategy in treating and assessing prognosis in critically ill patients. Foregoing trial treatments because of misconceptions regarding the ethics of withdrawing them later could deny patients important potential benefits.
What is the morally relevant difference between withholding and withdrawing?
The morally relevant features of withdrawing or withholding are the motives and intentions of reducing patient suffering and/or other burdens at end of life and of respect for patient autonomy. Since these motives are the same with both decisions, there is widespread agreement that, in most cases, withdrawing and withholding are morally equivalent [ 27 – 30 ]. This position has been supported by numerous professional and international organizations [ 2, 27 – 30] (see Table 14.1).
When did medical ethics change?
Physician refusal to comply with patient and family requests regarding treatments was not a prominent issue in medical ethics until the 1980s. The mid- to late twentieth century saw an evolution of medical decision making in the United States from being physician-centric (paternalistic) to being patient-centric. This change was driven by multiple factors: seemingly limitless advances in medical technology that raised complex moral questions about the nature of medical care, a political climate in the shadow of the Vietnam War in which antiauthoritarian philosophy flourished, and the increasing prominence of personal autonomy as a cultural value [ 40, 41 ].
What percentage of patients in the ICU are considered to be futile?
Treatment that is perceived to be futile is common in the ICU setting; in one study, approximately 20 percent of patients in the ICU were adjudged to have received futile (11 percent) or probably futile (8.6 percent) care [ 39 ].
Can a physician withdraw a medical treatment?
Sometimes physicians argue that they can unilaterally withdraw therapy if it has become futile because it no longer constitutes legitimate medical therapy. Legal decisions in the United States are not always in favor of the physician and depend on issues such as patient perceptions of futility, confusion over definitions of brain death, and other complex considerations. Western countries other than the United States tend to favor withdraw/withhold practices, but legal decisions vary elsewhere; in Japan, for example, some withdraw decisions have led to investigations of homicide [ 38].
Can a physician withdraw LST?
Cases have sometimes arisen in which physicians want to withdraw or withhold a patient’s LSTs over objections by the patient or surrogates, as in the case of Helga Wanglie [ 36 ,37 ]. In that case, the court ordered family wishes to be followed. It is important to note that such cases do not question the legality of withdrawing or withholding LST but whether it can or should be done against the patient’s or their surrogates’ will.
What is the legal basis for withdrawing LST?
Legal support for withdrawing or withholding LSTs is based in the United States on the ethical principle of respect for patient autonomy and in Constitutional provisions that limit government interference and protect the right of individuals to privacy. Between 1976 and 1990, the cases of Karen Ann Quinlan [ 31] and Nancy Cruzan [ 32] culminated in the codification of a patient’s right to limit or refuse LST in the Federal Patient Self-Determination Act of 1990 [ 33 ]. This law states that competent patients have the right to refuse any medical therapy, including LST, and that hospitals must apprise patients of these rights and act accordingly and without discrimination toward them. US hospitals have been sanctioned for violations of this Act [ 34 ]. In 2005, the durability of this legal decision was repeatedly tested as the case of Terry Schiavo wound its way through state and federal courts [ 35 ]. Every single court determined that withdrawal of a feeding tube was legally permissible even though it would result in Terry’s death. This principle survived attempts to legislate mandatory continuance of Terry’s tube feedings by the Florida state legislature and the US Congress; the US Supreme Court refused requests to reconsider.
What to do if you have experienced unethical behavior by a medical professional?
If you or a loved one have experienced unethical behavior by a medical professional, you may need to seek legal assistance. At the Weitz Firm, we will investigate your case in order to determine whether or not a medical professional’s unethical behavior crossed the line into medical malpractice. If so, we will work to secure compensation for any medical bills you incurred as a result, as well as lost income and any pain and suffering damages. Let our Philadelphia medical malpractice attorneys get to work investigating your case today. You can contact us for a free consultation by clicking here or calling 267-587-6240.
What are some examples of unethical behavior?
According to a Medscape study, doctors themselves described what they considered to be unethical behavior that can occur in their practice. This includes the following: 1 Withholding treatment to meet budgetary or insurance policy concerns 2 “Upcoding” to secure patient treatment from an insurer 3 Covering up a mistake 4 Taking money from medical device manufacturers or pharmaceutical companies 5 Failing to report an impaired colleague 6 Working while impaired by alcohol or drugs 7 Becoming romantically involved with patients or family members of a patient 8 Cherry-picking patients 9 Breaching patient confidentiality (violating HIPAA regulations) 10 Joking about patients or acting inappropriately while a patient is under anesthesia
Can a medical device be considered malpractice?
However, if that medical device ends up being defective, there may be a case of medical malpractice against the doctor. However, unethical behavior can still be reported.
Can unethical behavior cause harm?
Unethical behavior may or may not cause actual harm to a patient. For example, if a doctor takes money from a medical device manufacturer and subsequently uses that medical device on a patient, is this medical malpractice? If the patient has no adverse effects, and their condition improves, they have suffered no harm. However, if that medical device ends up being defective, there may be a case of medical malpractice against the doctor.
What is the duty of care in medical malpractice?
For a medical malpractice case to exist, there must have been a duty of care established between the doctor impatient. The duty of care then has to be breached in some way by the doctor, and this breach of duty must have caused harm to the patient. Unethical behavior may or may not cause actual harm to a patient.
Can you report unethical behavior in Pennsylvania?
However, unethical behavior can still be reported. Patients can report unethical behavior to a doctor’s supervisor, or they could file a complaint with the Pennsylvania Department of State. If a patient is harmed due to a doctor’s unethical behavior, they may need to file a medical malpractice lawsuit to recover compensation.
Clinical Decisions
Giving Treatment
- A medical treatment can have two basic functions. First it can aim to cure the person. This is the sort of treatment that we hope to receive when we visit our GP. Our desire is to go in, describe the problem, have a few tests and come away with the treatment that solves it. To an extent, curing is about warding off death, because if illness is not stopped then a person may die. You could say …
When to Withhold
- Treatments often carry risks, and a doctor needs to weigh up the balance between the potential for doing good and the potential for harm. People who are refused anti-biotics when they have a sore throat often feel let down, but the doctor has been weighing up the small chance of the drugs making any difference, against the very real risk that over-...
Respecting People
- Christians base treatment decisions on the fundamental principle of respect for the sanctity of human life. This is not altered if a person is very old or very young, physically able or has severe disabilities. For example, a recent discussion document from the British Medical Association says that the association 'finds unacceptable' the practice whereby people with conditions like Down'…
Best Interest
- One common guide is to look for the patient's 'best interest'. This can help when treating young children, or adults who are not fully conscious. In the past, best interest was almost always seen as prolonging life. However, a more complex assessment is needed now that medical technology can keep a person's body alive, perhaps inappropriately. Most people accept that there is no abs…
Double Effect
- Some doctors and lawyers argue that a treatment has a double effect. Pain-killing drugs given to cancer patients relieve suffering, but on occasions they also accelerate their death. This so-called 'double effect' is seen as being acceptable as the intention was not to kill the patient, but to reduce his pain. The phrase 'double effect' is unfortunate in that it suggests that two things were intend…
Laws and Guidelines
- The legal profession is increasingly being asked to give rulings about medical practice. While it is good that medical practice should be legally sound, there are dangers in having to get every difficult decision backed by a court ruling. To start with, in many cases the time taken to get a court decision would be too long and cause more harm than good. At the same time, doctors ar…