Eliminating the patient from being informed, or a part of the decision-making process is at best a questionable ethical practice. Still, "physicians cannot be forced (or even expected) to give 'futile' treatment to their patients" (Loewy 299). One question that should routinely be asked when making an ethical decision regarding futility is 'are there any better alternatives? '. Professional medical organizations have attempted to define futility and offer some guidelines for patient participation. Bagheri reports that "The American Medical Association’ s Council on Ethical and Judicial Affairs emphasizes providing a set of procedural guidelines to help direct physician-patient (or surrogate) conversations and decisions" (Bagheri 50).
The general result of these guidelines and standards is that ethical decisions must be made on a case-by-case basis and evaluated for each individual's unique situation. Still, the ethical process is daunting. According to Crawford and Way, "There are no predetermined scripts to be followed and it would be foolish to imagine that a protocol could ever be developed for the range of scenarios that might occur" (24). The result of the tensions that are expressed in regards to end of life care and medical futility are viewed through the dimensions of utility and deontology.
Deontology exerts an ethical force due to the duty to legalities, common law, or professional regulation, while utility imposes duties that "require healthcare professionals to consider the impact of their work on the individuals in receipt of care" (Cooke and Hurley 1373). As with many other situations that require an ethical decision-making process, the competing interests need to be considered in context with the individual patient's needs. Almost no issue in healthcare has raised more controversy and initiated more conflict than the legal, social, and political status of abortion.
The issue is compounded by the reality that almost no one favours abortion but preserves it as the least unfavourable alternative to an unwanted pregnancy.
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