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• W3126051567 abstract "What is significance of Baby Doe Regulations, regulations that have now been on books for a quarter of a century? Catalyzed by well-publicized death of a Down's syndrome baby whose parents declined routine intestinal surgery, Regulations remain a subject of debate. Alternately portrayed as protective civil rights legislation for handicapped and a ruinously meddlesome effort to constrict quality-of-life determinations for gravely ill newborns, Regulations add to our ongoing deliberations regarding concept of futility medicine. Promulgated 1985, Regulations (subject to certain exceptions) threaten withholding of federal funds if physicians treating infants less than one year of age [fail] to respond to infant's life-threatening conditions with treatment which, in treating physician's ... reasonable medical judgment are likely to be ... effective ameliorating or correcting all such conditions. The American Academy of Pediatrics and other commentators have interpreted Regulations to allow for exercise of clinical discretion. Critics counter that textual hints of flexibility are misleading. The rule's language, they argue, reveals a pro-life imperative that allows for little way of individualized, contextual decision-making.But, from a conflict resolution perspective, constricting nature of Baby Doe language hardly matters. Had regulations been written more nuanced fashion, practical import of text would likely remain same. Because we are unable to inject substantive content into concept of futile care, conventional wisdom holds that all that is left to us is good Attention has thus turned to alternative dispute resolution procedures as a means of coping with clash of expectations at bedside. When patients insist on care that clinicians deem futile, mediation is thought ideally suited to bring parties to a middle ground. Anchored precepts of procedural justice and disputant self-determination, the talking is considered best tonic to calm inflamed passions and bring warring parties to a peaceable end-point.The truth, however, is that mediation's procedural power rests, part, on substantive content of background legal and ethical norms. Mediation is a procedural echo chamber reflecting regnant legal norms. For those who believe that providing treatment to hopelessly ill newborns is bad medicine, mediation will prove a disappointing palliative. In disputes where family is driven by magical thinking or conviction that life its most compromised forms must be prolonged, mediation will do little to moderate their demands. And physicians, because they are risk-averse and feel disadvantaged litigation setting, are unlikely to press their case.This essay seeks to rescue mediation from threat of inflated expectations. Part I begins with a brief description of mediation and mediator's role encouraging settlement. Part II takes up mediation context of futility disputes, detailing what can reasonably be achieved, while pointing out limits. The essay concludes with two final points. First, relying on good process when clinicians and families disagree elides, but does not erase, substantive decisions that result. Resort to mediation many cases reflects a back-handed award of decisional authority to families and continued investment care that cannot cure and technology that cannot heal. This may be substantive outcome we want, but we should acknowledge choice. Second, if we acknowledge our normative choices, then perhaps we can revisit our earlier Hail Mary pass from substance to process. Unmasking tragic hidden under cover of good process may prompt us to reinvigorate our quest for a workable definition of futility. Better to forge ahead with this work then obfuscate choices we do make and set mediation up as fall guy for a problem not of its making." @default.
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• W3126051567 date "2012-01-01" @default.
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• W3126051567 title "The Baby Doe Regulations and Tragic Choices at the Bedside: Accepting the Limits of Good Process" @default.
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