Intended for healthcare professionals


Doctors not obliged to carry out treatment they think “futile”

BMJ 1999; 319 doi: (Published 23 October 1999) Cite this as: BMJ 1999;319:1088
  1. Tony Sheldon
  1. Utrecht

    In a legal test case a Dutch court has ruled that contrary to the wishes of the next of kin a hospital is not obliged to return an 80 year old patient with cancer to intensive care if his condition deteriorates.

    A judge in Utrecht ruled that doctors were not obliged tocarry out treatment that they regarded as “medically futile.” The decision about what treatment to give was a medical one for the doctors concerned following professional standards, he ruled.

    The patient's daughter, Sophie Hankes, had taken out a civil action against Utrecht's University Medical Centre, arguing that it had previously agreed to “complete treatment” to keep her father alive.

    But four of the hospital's intensive care consultants all agreed that it would be medically futile for the patient, now stable in a medium care bed, to receive further intensive care treatment if his condition deteriorated.

    Owing to the collapse of trust between the patient's family and hospital, the court ruled that the medical centre would have to cooperate in transferring the patient to another hospital that would offer intensive care. But it was the responsibility of the patient's family to find that hospital.

    Last July, Ms Hankes, who is her father's legal representative, was asked by doctors before an operation to remove a bowel tumour, whether her father should be put on a ventilator and resuscitated if there were an emergency. She replied she wanted the “complete treatment.”

    There were complications, and the patient remained in intensive care for seven weeks. Once stable he was transferred to a nursing ward, where doctors concluded that returning to intensive care would be medically futile because of factors including his irreversible bowel cancer, pre-existing heart condition, his general condition after a long stay in intensive care, and his old age.

    This is the first such legal case involving an elderly patient in the Netherlands and has raised questions over the rationing of intensive care for geriatric patients.

    The chairman of the medical centre's management board, Professor Geert Blijham, strongly denied that age discrimination or scarcity of beds had played a part, and he welcomed further debate over what was meaningful treatment.

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