The Courts, Futility, and the Ends of Medicine

Thaddeus Mason Pope

Mitchell Hamline School of Law; Australian Health Law Research Center, QUT; Saint Georges University; Alden March Bioethics Institute

Douglas White

affiliation not provided to SSRN

January 1, 2012

Journal of the American Medical Association, Vol. 307, No. 2, pp. 151-152, 2012

On August 13, 2010, the Appellate Division of the Superior Court of New Jersey declined to rule in the matter of Betancourt v. Trinitas Hospital, a case that raised questions about the limits of medicine in patients with advanced illness. In declining to rule, the judges wrote that resolving such issues in “the context of overheated rhetoric in the battlefield of active litigation” would not positively contribute to the policy debate around medical futility. These comments raise important questions about whether there is a role for the courts in helping to shape the boundaries of medical practice near the end of life.

One view is that courts should not provide guidance on medical futility disputes. Texas has formalized this belief into law. The Texas Advance Directives Act bars substantive judicial review when intractable conflict arises between clinicians and patients or their surrogate decision makers. It gives physicians and hospital committees authority to unilaterally withdraw life-sustaining treatment when they believe attempts to extend a patient’s life are inappropriate. The state medical associations in California, Washington, and Wisconsin have considered resolutions supporting similar legislation. Another view is that he possibility of appeal to the courts should be preserved because courts have an important role in ensuring fair deliberations between parties (e.g., families and physicians) of unequal power.

Both perspectives neglect a complexity: although judicial intervention is undesirable for the vast majority of decisions in medicine, preserving the possibility of appeal to the courts in medical futility cases may have beneficial effects at the societal level that are distinct from the benefits sought in individual cases. This viewpoint presents a justification for the limited judicial role in intractable futility disputes and delineates three potential benefits of preserving this option.

Keywords: medicine, death, dying, advance directives, Betancourt v Trinitas hospital, healthcare, end of life, life-sustaining, medical futility

JEL Classification: K32

Not Available For Download

Date posted: February 27, 2012  

Suggested Citation

Pope, Thaddeus Mason and White, Douglas, The Courts, Futility, and the Ends of Medicine (January 1, 2012). Journal of the American Medical Association, Vol. 307, No. 2, pp. 151-152, 2012. Available at SSRN: http://ssrn.com/abstract=2003479

Contact Information

Thaddeus Mason Pope (Contact Author)
Mitchell Hamline School of Law ( email )
875 Summit Avenue
Saint Paul, MN 55105
United States
651-695-7661 (Phone)
901-202-7549 (Fax)
HOME PAGE: http://www.thaddeuspope.com
Australian Health Law Research Center, QUT ( email )
2 George Street
Brisbane, Queensland 4000
Saint Georges University ( email )
West Indies
HOME PAGE: http://www.thaddeuspope.com
Alden March Bioethics Institute ( email )
47 New Scotland Ave
MC 153
Albany, NY 12208
United States
HOME PAGE: http://www.thaddeuspope.com
Douglas White
affiliation not provided to SSRN ( email )
Feedback to SSRN

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