MEDICAL FUTILITY DECISIONS AND PHYSICIANS LEGAL DEFENSIVENESS - THE IMPACT OF ANTICIPATED CONFLICT ON THRESHOLDS FOR END-OF-LIFE TREATMENT

Does legal defensiveness significantly influence physicians' assessmen ts of medical futility, in ways that may adversely affect the rights o f patients and their family members to make their own health care deci sions at the end of life? This exploratory study addresses that questi on with attitudinal data from a survey of 301 physicians practicing in academic medical centers in Texas. The majority of respondents indica ted that the probability of success defining futile treatment should h ypothetically be lower for patients with potential to benefit more fro m life-sustaining medical intervention (e.g. typically patients who ar e sentient), and higher for patients with less potential to benefit (e .g. patients in a persistent vegetative state). That is to say, physic ians normally perceive longer odds to be worth pursuing for greater po tential gain-a position that seems logically consonant with patients' rational self-interest. However, physicians with an attitude of extrem e legal defensiveness did not fit this pattern. Rather, they tended to define futility in a manner that would maximize the physician's latit ude to justifiably oppose patient preferences for end-of-life treatmen t abatement. These findings suggest that some physicians assume an adv ersarial position in their consideration of medical futility issues-an attitude that anticipates conflict with terminally-ill patients or th eir surrogates. The analysis presented here is not definitive, but at least raises the question of whether some physicians may inappropriate ly use their prerogative over medical futility as a means to guard the ir professional autonomy against perceived threats.