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Treatment Decisions for Terminally Ill Patients: Physicians' Legal Defensiveness and Knowledge of Medical Law

Published online by Cambridge University Press:  29 April 2021

S. Van McCrary ,
Jeffrey W. Swanson ,
Henry S. Perkins  and
William J. Winslade
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Extract

Wanzer, et al., have noted that “all too frequently, physicians are reluctant to withdraw aggressive treatment from hopelessly ill patients, despite clear legal precedent.” Our collective clinical experience confirms that this reluctance persists among some physicians. In this study, we investigated physicians’ attitudes, knowledge, and reported practices regarding the effects of perceived legal constraints on the abatement of life-sustaining treatment from patients who are clearly dying. A factor in assessing these issues is the concept of defensive medicine-that is, the perception that doctors are being forced to order every possible laboratory test and second opinion, or to continue providing non-beneficial life-sustaining treatment, solely to protect themselves from future legal claims. This perception appears widespread among practicing physicians. However, we believe that defensive medicine represents only part of a complex constellation of factors that comprise physicians’ reluctance to abate treatment. This phenomenon encompasses medical, ethical, legal, social, psychological, and spiritual factors interacting in ways that are not fully understood.

Type
Article
Information
Law, Medicine and Healthcare , Volume 20 , Issue 4 , Winter 1992 , pp. 364 - 376
Copyright
Copyright © American Society of Law, Medicine and Ethics 1992

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References

Wanzer, S.H., Federman, D.D., Adelstein, S.J. et al., “The Physician's Responsibility Toward Hopelessly Ill Patients: A Second Look,” New England Journal of Medicine 1989, 320:844–849.CrossRefGoogle Scholar
Manuel, B.M., “Professional Liability: A No-Fault Solution,” New England Journal of Medicine 1990; 322:627–631 (emphasis added).CrossRefGoogle Scholar
Perkins, H.S., Bauer, R.L., Hazuda, H.P., Schoolfield, J.D., “Impact of Legal Liability, Family Wishes, and Other ‘External Factors’ on Physicians' Life-Support Decisions,” American Journal of Medicine 1990; 89:185–194.CrossRefGoogle Scholar
Winslade, W.J., Weiner, K.S., Henderson, A. et al., The Texas Medical Jurisprudence Examination: A Self-Study Guide, Galveston, Texas: Institute for the Medical Humanities, University of Texas Medical Branch, 1990.Google Scholar
Barber v. Superior Court, 147 Cal. App.2d 1006, 195 Cal. Rptr. 484 (1983).Google Scholar
Paris, J.J., “The Decision to Withdraw Life-Sustaining Treatment and the Potential Role of an IEC: The Case of People v. Barber and Nejdl,” In: Cranford, R.E., Doudera, A.D., eds., Institutional Ethics Committees and Health Care Decision Making, Ann Arbor, Michigan: Health Administration Press, 1984, 203–208.Google Scholar
Gerrity, M.S., DeVellis, R.F., Earp, J.A., “Physicians' Reactions to Uncertainty in Patient Care: A New Measure and New Insights,” Medical Care 1990, 28:724–736.Google Scholar
See Perkins, et al., supra note 3.Google Scholar
Kapp, M.B., Lo, B., “Legal Perceptions and Medical Decision Making,” Milbank Quarterly 1986, 64 (Supp 2):163–202.Google Scholar
Toulmin, S., “Medical Institutions and Their Moral Constraints,” In: Bulger, R.E., Reiser, S.J., eds., Integrity in Health Care Institutions, Iowa City: University of Iowa Press, 1990, 21–32.Google Scholar
Tversky, A., Kahneman, D., “The Framing of Decisions and the Psychology of Choice,” Science 1981, 211:453–458.Google Scholar
See Perkins, et al., supra note 3.Google Scholar
Griffith, J., “Malpractice Lawyers' Latest Bullying Tactic,” Medical Economics October 7, 1985, 62:54–57.Google Scholar
See Toulmin, , supra note 10.Google Scholar
Ibid.Google Scholar
Ibid.Google Scholar
Weir, R.F., Gostin, L., “Decisions to Abate Life-Sustaining Treatment for Nonautonomous Patients: Ethical Standards and Legal Liability for Physicians after Cruzan,” JAMA 1990; 264:1846–1853.CrossRefGoogle Scholar
Jacobson, J.A., Tolle, S.W., Stocking, C., Siegler, M., “Internal Medicine Residents' Preferences Regarding Medical Ethics Education,” Academic Medicine, December, 1989; 760–764.Google Scholar
Davidson, K.W., Hackler, C., Caradine, D.R., McCord, R.S., “Physicians' Attitudes on Advance Directives,” JAMA 1989, 262:2415–2419.Google Scholar