The main debate concerns situations in which patients, or in many cases their family members, request treatment at the end of life that many physicians feel to be of no real benefit to the patient. In other words, Steven H. Miles and Felicia Ackerman debate whether or not physicians are required or morally obligated in some way to fulfill the wishes of dying patients for treatment that may not be beneficial. While such situations are rare, the debate highlights a unique perspective in the continuing debate on end of life care.
Physician Steven H. Miles in his article “Informed Demand for ‘Non-Beneficial’ Medical Treatment” argues that physicians have the right to refuse treatment that they feel is “futile.” In essence, he believes that doctors have the right to refuse the requests of dying patients or their families for treatment that the medical establishment feels will not better the condition of the dying patient. Philosopher Felicia Ackerman, on the other hand, outlines the argument against a physicians’ ability to refuse demands for “futile” treatment in her article “The Significance of a Wish.” She believes that wishes of dying patients and their families should be respected and carried out to the best of the ability of the physician.
In “Informed Demand for ‘Non-Beneficial’ Medical Treatment,” Steven Miles discusses the case of Mrs. Helga Wanglie, an elderly woman in a persistent vegetative state kept alive on a respirator for several months at the request of her husband and daughter. In light of this illustration of futile medical care, Dr. Miles argues that the right of a physician to refuse such costly, unbeneficial treatment should be upheld. He believes that the administration of such treatment drains financial resources that could be better allocated to individuals for which beneficial treatment exists. In his point of view, such treatment puts financial strain on medical insurance holders and taxpayers.
Felicia Ackerman, on the other hand, feels that physicians are obligated to fulfill the wishes of dying patients and their families, even if that includes perceived “futile” treatment. In her article “Significance of a Wish,” Ms. Ackerman calls into question Dr. Miles’ condemnation of Mrs. Wanglie’s treatment as “medically inappropriate.” In her view, Ms. Ackerman believes that Mrs. Wanglie’s treatment is medically appropriate due to the conclusion that such treatment is consistent with Mrs. Wanglie’s wishes. In other words, the respirator would presumably allow Mrs. Wanglie to die under the circumstances she’d prefer. The fulfillment of such a wish, from Ms. Ackerman’s standpoint, justifies expense of medical treatment viewed by some physicians as futile and serves the medically important role of establishing trust between doctor and patient.
Key terms to understanding the debate include: non-beneficial, ventilator, and persistent vegetative state. The term “non-beneficial” as it relates to medical treatment signifies the absence of perceived improvement of the condition of the patient or in the patient’s quality of life after the course of the treatment. A ventilator is simply a machine that assists patients unable to breathe on their own with the mechanical act of breathing. The term persistent vegetative state can be defined as the state of a patient who is unconscious and unable to breathe on his or her own. In addition, there is very little chance that the patient will awaken from the vegetative state.
