Wrong Medicine

Cover

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Contents

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pp. vii-

Preface to the Second Edition

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pp. ix-xi

When Johns Hopkins University Press editor Wendy Harris, who skillfully shepherded the first edition of Wrong Medicine: Doctors, Patients, and Futile Treatment, invited us to prepare a second edition, we were happy to accept. Since the original publication of our book in 1995, we have witnessed new conceptual, legislative, judicial, and clinical developments that support and...

Acknowledgments

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pp. xiii-

1. Are Doctors Supposed to Be Doing This?

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pp. 1-22

More than 20 years before the permanently unconscious Terri Schiavo unwittingly starred in a nonstop cable television circus, the travails of another permanently unconscious young woman made headlines in the daily newspapers and prompted a landmark “right to die” decision by the U.S. Supreme Court.¹Her name was Nancy Cruzan. While driving home from her job in a...

2. Why It Is Hard to Say No

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pp. 23-36

Ethics consultations take many forms. They range from nocturnal phone calls from resident physicians worried about the legal risk of accepting a patient’s request for a Do Not Attempt Resuscitation (DNAR) order, to bedside discussions in the intensive care unit (ICU) with distraught or resigned patients, to strained and lengthy conferences involving every combination of patient, ...

3. Why We Must Say No

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pp. 37-56

Rarely had one of us seen the medical team look so beleaguered. Hunched around the conference room table, the nurses, interns, residents, social worker, and attending physician—a bright, well-read, and compassionate woman new to the faculty—all conveyed the same message: We’re trapped. The medical record they handed over, only the latest of a number of volumes, was several...

4. Families Who Say, “Do Everything!”

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pp. 57-73

Helga Wanglie was 85 years old when she had an accident common to all of us, but potentially deadly for elderly people: she tripped on a rug. She tumbled to the floor and broke her hip. During the time it takes for the fracture to heal, patients confined to bed, as Mrs. Wanglie was, can fall prey to developing blood clots, bed sores, and pneumonia. Up to 20 percent of elderly patients...

5. Futility and Rationing

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pp. 74-88

Juanita was an eight-year-old Mexican girl who had acute lymphocytic leukemia. Her mother would transport her across the border to a university medical center in the United States whenever her daughter began to lose weight and become severely weak. The university hospital doctors who made the original diagnosis and prescribed the chemotherapy treated her even though they knew...

6. Medical Futility in a Litigious Society

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pp. 89-103

One summer day in 1988, six-month-old Sammy Linares attended his last birthday party. In the midst of festivities, he choked on a deflated balloon. By the time his father, Rudy Linares, noticed what had happened, the baby was already blue and unconscious. Frantically, the father attempted mouth-to-mouth resuscitation, then picked the child up and ran half a block to a...

7. Ethical Implications of Medical Futility

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pp. 104-130

In Chapter 6 we noted that physicians and hospitals have sometimes forced patients to undergo futile treatments out of a misplaced fear of legal liability. If we look back to the decades of the 1970s and 1980s, we find that the ethical cases gaining attention most typically dealt with situations of this sort: patients or families wished to withdraw treatment, but the health care...

8. The Way It Is Now/The Way It Ought to Be: For Patients

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pp. 131-143

The case of Mary O’Connor, a 77-year-old widow who had a series of progressively debilitating strokes that left her bedridden, with dementia and paralysis, is often cited in ethics and the law as an important case in the evolving debate over the right of family members to refuse unwanted treatment on behalf of patients. It also provided us with one of the earliest insights into the...

9. The Way It Is Now/The Way It Ought to Be: For Health Professionals

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pp. 144-166

Dora Sauell (not her real name), a widow of some seven years, liked to spend her days bustling from one neighbor to another, keeping up with the latest gossip in the trailer park. One day she awoke with severe chest pain, called 911, and was rushed by ambulance to the emergency department of a nearby hospital, a journey that began a four-month odyssey of complications in the...

10. The High Points: Medical Futility

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pp. 167-182

In October 1992 a baby was born in a Virginia hospital with most of her brain, skull, and scalp missing—a condition called anencephaly. Because of this condition, which was recognized by ultrasound before birth, the baby, known as Baby K, was destined never to be conscious, able to think, see, hear, or otherwise interact with her environment. The physicians explained to Baby K’s...

11. Medical Futility: Where Do We Stand Now?

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pp. 183-193

In our original journal article on medical futility, before the publication of the first edition of Wrong Medicine, the two of us, along with our colleague the philosopher and bioethicist Albert R. Jonsen, introduced a definition of medical futility and discussed its ethical implications.¹ We realized that although the concept had been acknowledged and respected even before the time of...

Notes

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pp. 195-220

Index

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pp. 221-230