Substantial resources (supply costs and manpower) are often invested in this clinical setting, in which there is a low likelihood of benefit, while the care of other patients is delayed ( distributive justice ).
Under Bolam test , a doctor is not negligent if what he has done is accepted by a responsible body of medical opinion.
Under the Bolitho case , the court must be satisfied that the exponents of a body of professional opinion have a logical basis and had directed their minds to the comparative risks and benefits in reaching a defensible conclusion. The opinion of the expert witnesses must be founded on logic and good sense.
…“ futility is a professional judgment that takes precedence over patient autonomy and permits physicians to withhold or withdraw care deemed to be inappropriate without subjecting such a decision to patient approval.”
Schneiderman LJ, Jecker NS, Jonsen AR. Medical futility: its meaning and ethical implications. Ann Intern Med. 1990 Jun 15;112(12):949-54.
“ It is wise for a doctor to seek a second opinion in making a momentous decision to withhold resuscitation for fear of the doctor’s own personal values, or the questions of available resources might influence his/her decision.”
European Resuscitation Council, Resuscitation Guidelines 2005
DNAR order means just that - in the event of cardiopulmonary arrest, CPR should not be attempted at all. Other treatment should be continued; e.g. pain relief, sedation on required basis in terminal illnesses.
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity – WHO Definition, 1948
A 80-year old man with history of frequent exacerbation of COPD is diagnosed with acute pulmonary edema, currently complicated with respiratory failure Type 2. All other treatment modalities fail to prevent his deterioration. You know that his prognosis is not good but he needs mechanical ventilation to support his worsening respiratory effort.
Would you have intubated him?
If the relatives insist on you to actively resuscitate him but you do not, would you be liable to be sued?