Research Report: A Preliminary Analysis of Medical Futility Decisionmaking: Law and Professional Attitudes

The debate in medical futility decisionmaking centers on the conflict between a patient insisting treatment and a doctor refusing to furnish it. Courts have taken two disparate approaches to the legal status of medical futility. Believing that such legal ambiguity may reflect ambiguity in the medical profession itself, this research report sought to identify any emerging consensus among professionals handling medical futility issues. The report explains the results of the Life Sustaining Treatment Survey, a nationwide survey of health care professionals at hospitals. Presented with a list of criteria, respondents assigned important ratings to the factors used in recent futility decisions at their institutions. The resulting data suggests that there is no consensus among professionals in medical futility decisionmaking. The data supports at least three distinct approaches for making futility decisions: emphasis on the patients’ preferences; providing for the patient and family; and adhering to objective medical and social norms. It is unlikely that the law will realize its full potential to regulate futility judgments until explicitly articulated professional standards emerge. This article advocates continued empirical research to document and test professional judgment principles. Such research may ultimately help identify factors that will form the basis for a consensus in medical futility decisionmaking

Regulating Conflicts of Interest in Research: The Paper Tiger Needs Real Teeth

This article describes the current state of the regulation of financial conflicts of interest in research in the United States. It notes the implications of the changing academic and private research environment and reviews recent empirical research on (1) the perceived implications of such conflicts on clinician and researcher behavior, and (2) the effect of disclosure of such conflicts to potential research participants. The article also details a number of widely publicized research “scandals” involving conflicts of interest and the effects these may have on both public support for research as well as on the quality of care that ultimately is delivered. The article then discusses current U.S. federal regulations and initiatives by institutions and professional organizations to further guide researchers and describes how conflicts of interest are typically managed by institutions. It also presents a taxonomy of researcher reactions to efforts by institutional conflict of interest committees to regulate these conflicts. It notes critiques by the Office of the Inspector General of the U.S. Department of Health and Human Services (OIG) of the government\u27s role in the current interplay between government agencies, research sponsors, and institutions in regulating conflicts. Concluding that current efforts to regulate conflicts are inadequate, the article sets forth a proposal for reform of the way conflicts of interest are managed at both the federal and institutional levels

Research Report: A Preliminary Analysis of Medical Futility Decisionmaking: Law and Professional Attitudes

The debate in medical futility decisionmaking centers on the conflict between a patient insisting treatment and a doctor refusing to furnish it. Courts have taken two disparate approaches to the legal status of medical futility. Believing that such legal ambiguity may reflect ambiguity in the medical profession itself, this research report sought to identify any emerging consensus among professionals handling medical futility issues. The report explains the results of the Life Sustaining Treatment Survey, a nationwide survey of health care professionals at hospitals. Presented with a list of criteria, respondents assigned important ratings to the factors used in recent futility decisions at their institutions. The resulting data suggests that there is no consensus among professionals in medical futility decisionmaking. The data supports at least three distinct approaches for making futility decisions: emphasis on the patients’ preferences; providing for the patient and family; and adhering to objective medical and social norms. It is unlikely that the law will realize its full potential to regulate futility judgments until explicitly articulated professional standards emerge. This article advocates continued empirical research to document and test professional judgment principles. Such research may ultimately help identify factors that will form the basis for a consensus in medical futility decisionmaking