The hospital should always defer to the patient and family that has an advanced directive in place, and if the patient cannot speak for themselves but has an advanced directive, then a proxy must make the decision. The only case where the hospital should be allowed to make the decision on futile care is in the absence of a proxy, in the absence of an advanced directive, and only if it is in the best interest of the patient.
In this psychological-based model, the healthcare professional and hospital is put in the position of negotiating with the family and/or patient. Burns and Truog (2007) state that in these situations the healthcare professional should always follow the wishes of the patient's family in futile care efforts (Burns & Truog, 2007). However, that view places a burden on the healthcare professional to compromise medical principles when that professional deems the care to be inappropriate and ultimately unnecessary (Forde, 1998).
In brief, there may be situations that are very clearly defined as situations where futile care is not warranted; in other situations the issue may not be so easy to determine and requires more objective clarification. Marsden (1995) examined data from a six-year time period of cardiac arrests for the Scottish Ambulance Service. The finding was that those patients with a non-shockable rhythm never survived resuscitation attempts. The results of the Marsden study led to the development of guidelines for ambulance personnel in Scotland given in the form of a quick algorithm that could be used on scene (Marsden, Ng, Dalziel, & Cobbe, 1995).
Conclusion
The hospital, in designing a futile care policy, must adhere to state ethical standards and state laws. In the State of Massachusetts, for example, it is punishable...
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