The question here is whether the continued treatment by the medical staff was ethical.  However, there are some points that need to be addressed in the scenario.  This commentary will briefly look at these points but also futility from a Catholic perspective.

     This case study poses some interesting concepts.  First, we need to look at the concept of futility.  Futility can be looked at in two ways.  The strict concept of futility requires that a patient be a point medically where any further treatment would not improve the patient’s chance of survival.  This usually means that the patient is on a ventilator with multiple medications to maintain blood pressure and the pt is either not improving or is getting worse.  The more subjective view of futility looks at quality of life of the critically ill and the long term condition of the patient, should they survive the event.  Most hospitals still use the stricter concept of futility in addressing potentially futile cases.

     Another fact that needs to be looked at is that this involves a neonatal patient.  Futile care is a topic that is more easily handled when the patients are adult.  Healthcare providers generally have an easier time when the patient has lived their life.  In cases that involve pediatric or neonatal patients, there is hesitance in looking at care as futile.  It would appear that there are two reasons for this.  First, in the neonatal and pediatric populations, care is more focused around the family and the patient.  With adult patients, the family may be involved but not the degree that it is with pediatric patients.  Families need more time in addressing and coping with end of life issues.  The second reason would involve uncertainty of the medical staff.  According to Fine, Whitfield, Carr, and Mayo in 2005, this topic is “so fraught with not only medical and ethical uncertainty but legal uncertainty as well”. 

     From a Catholic perspective, Directive 56 of the Ethical and Religious Directives for Catholic Health Care Services addresses this issue.  This directive looks at care as ordinary or proportionate.  Proportionate care is defined as offering “reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community” (2001).  In this case, futility can be decided based on the definition.  The pt is at a point where there may be an occasional improvement but there is an overall deterioration in the patient’s clinical condition.  There does not seem to be a “reasonable hope of benefit”.

     In looking at this case, was it ethical for the healthcare team to keep treating MW.   Yes, it would be ethical.  In reading the case study, it appears that the family had some religious reservations in withdrawing care based on futility.  While it would be ethically appropriate for the team to declare is care futile and withdraw care (the team even consulted an outside, independent opinion), it is also appropriate to allow the family to have their time and to continue to treat the patient.  Remember in pediatrics, it is also about treating the family and allowing them to address the situation in their own way.

Reference:

Fine, R., Whitfield, J., Carr B., Mayo, T. “Medical Futility in the Neonatal Intensive Care Unit: Hope for a Resolution”. Pediatrics. 2005; 116: 1219-1222