Debating Medical Utility, Not Futility: Ethical Dilemmas in Treating Critically Ill People Who Use Injection Drugs

The Journal of Law, Medicine & Ethics : a Journal of the American Society of Law, Medicine & Ethics
Stephen R BaldassarriGail D'Onofrio

Abstract

Physicians who care for critically ill people with opioid use disorder frequently face medical, legal, and ethical questions related to the provision of life-saving medical care. We examine a complex medical case that illustrates these challenges in a person with relapsing injection drug use. We focus on a specific question: Is futility an appropriate and useful standard by which to determine provision of life-saving care to such individuals? If so, how should such determinations be made? If not, what alternative decisionmaking framework exists? We determine that although futility has been historically utilized as a justification for withholding care in certain settings, it is not a useful standard to apply in cases involving people who use injection drugs for non-medical purposes. Instead, we are welladvised to explore each patient's situation in a holistic approach that includes the patient, family members, and care providers in the decision-making process. The scope of the problem illustrated demonstrates the urgent need to definitively improve outcomes in people who use injection drugs. Increasing access to high quality medication-assisted treatment and psychiatric care for individuals with opioid use disorder will help our...Continue Reading

References

Jan 1, 1990·Journal of Psychoactive Drugs·J P Hoffmann
Sep 26, 1997·Hepatology : Official Journal of the American Association for the Study of Liver Diseases
Jul 21, 2001·The New England Journal of Medicine·B R EdlinB Lo
Jun 6, 2002·Journal of General Internal Medicine·Joseph O MerrillKatharine A Bradley
Nov 14, 2003·The New England Journal of Medicine·Jane C Ballantyne, Jianren Mao
Feb 5, 2011·Current Opinion in Anaesthesiology·Dominic J C Wilkinson, Julian Savulescu
Apr 10, 2014·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Paul MartinMichael Fallon
May 6, 2014·The Annals of Thoracic Surgery·Sarah C Hull, Farid Jadbabaie
Dec 3, 2014·Journal of Hepatology·Rachel H Westbrook, Geoffrey Dusheiko
Jun 23, 2015·The Annals of Thoracic Surgery·Nabin K ShresthaSteven M Gordon
Sep 17, 2015·Circulation·Larry M BaddourUNKNOWN American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular
Jan 28, 2016·The New England Journal of Medicine·Nora D VolkowA Thomas McLellan
Jan 31, 2016·Interactive Cardiovascular and Thoracic Surgery·Oda Bratland ØsterdalRune Haaverstad
Jan 10, 2018·The American Journal of Bioethics : AJOB·Daniel Z Buchman, Marie-Josee Lynch
Jan 10, 2018·The American Journal of Bioethics : AJOB·Ruchika Mishra
Jan 10, 2018·The American Journal of Bioethics : AJOB·James N Kirkpatrick, Jason W Smith

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Citations

Sep 29, 2018·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Bruno ChicoulaaMarie-Eve Rougé Bugat
Oct 13, 2020·The Clinical Teacher·Riley D Shearer

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