More on Patient's Best Interest or Is It the Physician's Interest?

As I implied in the previous posting, the physician does experience a conflict of interest when deciding what to do with his/her patient's request. Issues regarding denial of the request deal with concern about an "angry" or difficult or non-complient patient to manage in the future, loss of a patient to another physician, and finally malpractice suit by the patient or family for failure to diagnose or treat. Thus some physicians may feel it is really in their own best interest to agree to the patient or family's request. This has led, for example, in terminally ill patients,within intensive care units, apparent physician denial of the fact that the patient is dying and that any of the multitude of treatments and life-support being provided is futile with regard to any recovery. Full cardio-pulmonary resusitation in case of a cardiac arrest is continued despite the fact that this traumatic procedure usually does nothing than break ribs or may occasionally prolong the dying process. Often the physician may speak to his/her colleagues about a "no hope" prognosis but refuse to write this opinion in the chart or write orders appropriate for that prognosis. Interestingly, it is often the nursing staff who recognize the irrational decision-making by the physicians and bring the matter to hospital ethics committees for resolution. Extreme examples of the influence of family's requests to physicians and hospitals include those requests which have led to patients who are dead taken home by the family with ventilation machines working. In all these examples, whose interest is being served: family, physician, hospital?-- certainly not that of the patient. ..Maurice.