When Doctors Say No

The medical situation is critical, even life-threatening. The doctor refuses to offer or to continue providing a medical treatment. The patient, or the patient's family, insist that everything possible must be done. The doctor says no, such a treatment is futile. In the face of such a conflict, what should be done and who should decide? Should physicians be permitted to unilaterally refuse to provide treatment that they deem futile? In this book, philosopher and bioethicist Rubin examines this controversial issue. She offers a critique of the concept of medical futility and the debate surrounding it, and she calls for more public debate about the underlying issues at stake for all of us - patients, families, health care providers, insurers, and society at large.For many years, the field of bioethics was preoccupied not with the physician's but with the patient's right to say no to unwanted medical treatment. Today the tables have turned and it is the health care professionals who want to refuse medical treatments they deem futile. Significantly, questions about what physicians should do in the face of demands for such treatments have arisen more frequently now, in this era of health care competition, managed care, and increased focus on costs and the bottom line. But despite pressures to set limits, many of them legitimate, Rubin argues that the futility debate, and the policies and practices that have evolved in response to it, are misguided. She rejects the popular arguments supporting unilateral decision making by physicians, and calls instead for a different kind of conversation about the central values at stake when doctors and patients so dramatically disagree. "Medical Ethics Series", David H. Smith and Robert M. Veatch, Editors.