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Editorials: POINT/COUNTERPOINT EDITORIALS |

Point: The Texas Advance Directives Act Effectively and Ethically Resolves Disputes About Medical Futility

Robert L. Fine, MD
Author and Funding Information

Affiliations: Dr. Fine is Director of the Office of Clinical Ethics and Palliative Care for Baylor Health Care System, Chairperson of the Institutional Ethics Committee at Baylor University Medical Center, and Director of the Palliative Care Consultation Service at Baylor University Medical Center.

Correspondence to: Robert L. Fine, MD, Office of Clinical Ethics and Palliative Care, Baylor Health Care System, 3434 Swiss Ave, Suite 205, Dallas, TX 75204; e-mail; robertf@baylorhealth.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(4):963-967. doi:10.1378/chest.09-1267
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Extract

This clinical scenario is familiar to physicians, nurses, and other health-care professionals who treat seriously ill patients. Although we prefer the role of Asclepios, in some cases we take on the role of the Danaides attempting to fill a leaking cistern. Our patient cannot recover enough to live free from the hospital, is either suffering or unable to appreciate any joy in being alive, and cannot die easily or peacefully without permission. We conclude that further aggressive treatment is futile. Most surrogates will agree and may have come to the same sad conclusion before the physician. On occasion, however, that permission is not forthcoming, as in this case, and we no longer face the problem of medical futility; we face a medical futility conflict.

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