The Barnes Case: Taking Difficult Futility Cases Public

Authors

  • Ruth A. Mickelsen,

    1. Affiliate Faculty at the Center for Bioethics and a Senior Lecturer at the School of Public Health at the University of Minnesota.
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  • Daniel S. Bernstein,

    1. Intern at the University of Minnesota's Center for Bioethics.
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  • Mary Faith Marshall,

    1. Director of Programs in Biomedical Ethics at the Center for Biomedical Ethics and Humanities, and a Professor of Public Health Sciences at the School of Medicine, and a Professor of Nursing at the School of Nursing at the University of Virginia.
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  • Steven H. Miles

    1. Professor of Medicine and Maas Family Chair of Bioethics at the University of Minnesota Medical School in Minneapolis.
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Abstract

Futility disputes are increasing and courts are slowly abandoning their historical reluctance to engage these contentious issues, particularly when confronted with inappropriate surrogate demands for aggressive treatment. Use of the judicial system to resolve futility disputes inevitably brings media attention and requires clinicians, hospitals, and families to debate these deep moral conflicts in the public eye. A recent case in Minnesota, In re Emergency Guardianship of Albert Barnes, explores this emerging trend and the complex responsibilities of clinicians and hospital administrators seeking to replace an unfaithful surrogate demanding aggressive therapy. Use of the courts requires the coordinated commitment of significant institutional resources, management of intense media scrutiny and individual and organizational courage to enter the unpredictable world of litigation. Given the dearth of legislative guidance on medical futility, individual clinicians and institutions will continue to bear the difficult responsibility for resolution of individual futility disputes. The Barnes case illustrates how one institution successfully used the judicial system to replace an unfaithful surrogate, cease the provision of inappropriate aggressive care, and stimulate a community dialogue about appropriate care at the end of life.

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