Resolving Futility/NBT/PIT Conflicts - Lessons from Abortion Uncertainty

In a long series of articles starting in 2007, I argued that one problem with laws that grant legal immunity for unilaterally withholding or withholding life-sustaining treatment is uncertainty. Which treatments are "contrary to generally accepted healthcare standards"? Which ones are "medically ineffective"?

This same uncertainty pervades abortion. Even though most criminal abortion laws contain exceptions for life or health of the mother or for other reasons, they are vague. What does the risk of death have to be? And how imminent must it be? 

An article addressing "Physician Decision Making Under Uncertainty in a Post-Dobbs America" offers a path forward in the abortion context which parallels the path generally recommended for ICU conflicts over futile/NBT/PIT treatment. Here is the abstract.

"This Article argues that clinical workflows, developed by physicians with support from hospital administration and legal counsel, should be implemented in the setting of pregnancy-related medical emergencies. Such workflows, drafted through a consensus-based process with input from evidence-based practice and society guidelines, have at least two significant benefits." 

"First, they minimize uncertainty in the decision-making process, counteracting psychological biases and promoting legitimate patient-care efforts to improve patient outcomes. Second, collaborative development of such standards with input from physicians, ethicists, hospital administration, and lawyers will increase buy-in from courts, increasing the likelihood that treatment choices will be deemed consistent with state laws."

"These twin objectives should operate to streamline treatment options and save lives, as well as providing post facto protection to physicians who have made good faith decisions in emergency contexts. In sum, the adoption of clinical workflows will not only promote sound decision-making but will also mitigate impacts caused by delays in care by promoting consistent, standardized practices for intervening when such situations arise."

Molly J. Walker Wilson, J.D., Ph.D.