HuMed is a podcast hosted by pediatric emergency physician Dr. David Spiro, exploring the human side of medicine. A recent episode tackles medical futility.
"Two attending physicians declared medical futility on a man in his late 40s. He was awake. He was begging for the ICU. He was begging for his mother. And the only doctor at his bedside that night was an intern on his second call shift. Dr. Robert Beck has carried that night for nineteen years."
A notable part of the discussion focuses on the patient's race. Had the patient not been African American, clinicians might not have refused treatment.
This highlights a persistent gap in resolution of non-beneficial treatment conflicts. While policies consistent with professional society guidelines and state law may effort procedural due process, they only assure fairness only in the instant case. They fail to prevent disparate application of the NBT policy in the first place.
A hospital might have 2 clinically identical patients. But the NBT policy is invoked for only one of them. And that non-uniform application may be driven by bias. Because most NBT policies are bottom-up and opt-in, there are few controls to mitigate these risks.
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