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Medical Ethics |

Reason-Giving and Medical Futility: Contrasting Legal and Social Discourse in the United States With the United Kingdom and Ontario, Canada

Gabriel T. Bosslet, MD; Mary Baker, MD; Thaddeus M. Pope, JD, PhD
Author and Funding Information

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

aIndiana University Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Indianapolis, IN

bCharles Warren Fairbanks Center for Medical Ethics, Indiana University Health Methodist Hospital, Indianapolis, IN

cMitchell Hamline School of Law, St Paul, MN

CORRESPONDENCE TO: Gabriel T. Bosslet, MD, Division of Pulmonary, Critical Care, Allergy, and Occupational Medicine, Indiana University School of Medicine, 1120 W. Michigan St, CL 285, Indianapolis, IN 46202


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(3):714-721. doi:10.1016/j.chest.2016.05.026
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Disputes regarding life-prolonging treatments are stressful for all parties involved. These disagreements are appropriately almost always resolved with intensive communication and negotiation. Those rare cases that are not require a resolution process that ensures fairness and due process. We describe three recent cases from different countries (the United States, United Kingdom, and Ontario, Canada) to qualitatively contrast the legal responses to intractable, policy-level disputes regarding end-of-life care in each of these countries. In so doing, we define the continuum of clinical and social utility among different types of dispute resolution processes and emphasize the importance of public reason-giving in the societal discussion regarding policy-level solutions to end-of-life treatment disputes. We argue that precedential, publicly available, written rulings for these decisions most effectively help to move the social debate forward in a way that is beneficial to clinicians, patients, and citizens. This analysis highlights the lack of such rulings within the United States.


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