Wrong Medicine: Doctors, Patients, and Futile Treatment

by Lawrence J. Schneiderman

In Wrong Medicine, Lawrence J. Schneiderman, M.D., and Nancy S. Jecker, Ph.D., address issues that have occupied the media and the courts since the time of Karen Ann Quinlan. The authors examine the ethics of cases in which medical treatment is offered-or mandated-even if a patient lacks the capacity to appreciate its benefit or if the treatment will still leave a patient totally dependent on intensive medical care. In exploring these timely issues Schneiderman and Jecker reexamine the doctor-patient relationship and call for a restoration of common sense and reality to what we expect from medicine. They discuss economic, historical, and demographic factors that affect medical care and offer clear definitions of what constitutes futile medical treatment. And they address such topics as the limits on unwanted treatment, the shift from the "Age of Physician Paternalism" to the "Age of Patient Autonomy," health care rationing, and the adoption of new ethical standards.

216 pages, Paperback

First published January 1, 1995

Reviews

[Jess B · Rating 3 out of 5]

I really wanted to like this book. The basic premise is that "although medicine has great powers, it does not have unlimited powers, and although medicine has great obligations, it does not have unlimited obligations. The duty of the profession is to benefit the patient. Nothing less and nothing more." (page 136, repeated elsewhere throughout book) I wholeheartedly agree with that. The controversial part comes when one tries to define what counts as beneficial. One of their criteria for treatment to be considered beneficial is that it must be able to help the patient leave the hospital (permanent residence in an ICU until one dies is not the goal), which makes sense to me. Their second criteria is that for a treatment to be beneficial, the patient must be conscious. My complaint with this book is that they are heavy-handed about this point. They base their argument on the fact that they believe that patients who are permanently unconscious are not persons but merely human beings, a distinction that I don't agree with. There is a lot that has and could be said about the goals of care and ethics of care in these patients, and most of what is said is not nuanced or gentle, which I think is a failing, not only of this book, but of the medical professions as a whole, and society in general. This book makes a lot of good points and strong arguments, which I appreciated, but I don't agree with how they dealt with that part of the discussion.
The book is written mainly focused on doctors, although with some attention put towards nurses and other members of the healthcare team. It includes a chapter written directly for patients. I strongly believe that this discussion needs to start taking place, and that writing a chapter specially for the general public is a good idea. But I'm afraid that the chapter is not as useful as it could be, because it starts by arguing against the "sanctity of life" principle, and I am concerned that this will turn many people off from reading and listening to the whole discussion. Again, they are not as nuanced and gentle as I think this subject deserves, and I fear that many people will be turned off from the good points in the book by the general tone.

[Kelly · Rating 1 out of 5]

Did not finish. I was told to read this by a colleague, but the authors are so convinced of the rightness of their own position (that much modern medical treatment is futile—essentially, though I know this from other writings of theirs rather than getting far enough into this book, because they think people lacking cortical function from brain damage or severe illness no longer count as people) and dismissive bordering on mocking of anyone who disagrees with them (especially attacking religious people, of whom I am one) that I couldn’t handle more than the introduction and one chapter.