Eric M. Levine


Part II of this article discusses the concept of futility and reviews various proposed approaches to defining "futility". This article then shows how personal value judgments play an integral part in determining futility under virtually all of these approaches. Part II concludes that a decision that treatment is futile should not be based on the individual values of only the patient or physician under the shared decisionmaking model of the physician-patient relationship. Part III tackles the issue whether a physician must offer or continue treatment deemed "medically and ethically inappropriate." Part III first reviews common law doctrines governing the physician-patient relationship and concludes that these doctrines do not require the physician to provide every treatment a patient demands, especially when providing such treatment would force the physician to act contrary to her professional conscience. Part III also discusses the various state statutes affording physicians the right not to render treatment considered medically inappropriate or not to participate in treatment that would violate the physician's professional or personal conscience. Part III then discusses a recent Fourth Circuit case holding that physicians are obliged to provide treatment to demanding patients with emergency medical conditions, as defined in the Emergency Medical Treatment and Active Labor Act, even though physicians determine that treatment is medically and ethically inappropriate. Part III concludes that, excepting any applicable statute to the contrary, the prevailing standard of medical care is the only thing obliging a physician to continue or offer treatment to a demanding patient, and that the standard of care will rarely, if ever, require a physician to provide medically and ethically inappropriate treatment. Finally, this article concludes that the standard of care ultimately should dictate whether a physician is obliged to prescribe or render treatment deemed medically inappropriate, the provision of which is contrary to the physician's professional conscience. When a physician is faced with a situation in which the patient demands treatment held to be medically inappropriate by a general consensus of health care providers, the provision of which would contravene the physician's conscience, the physician should try to resolve the conflict amicably. The physician should engage in a discussion with the patient and try to come to an agreement. If both the physician and patient cannot come to terms, the physician should, with reasonable diligence, attempt a transfer. If a transfer is not possible, then the physician may refuse to offer or continue such treatment.