In the November 2015 issue of the AMA Journal of Ethics, three Mayo Clinic researchers published “Grow a Spine, Have a Heart: Responding to Patient Requests for Marginally Beneficial Care.”
42-year-old Ms. Hollowell asks Dr. Perry for a referral for a mammogram. Dr. Perry believes that, because Ms. Hollowell is between 40 and 50 and is in a low-risk group based on the new screening guidelines, a mammogram is unnecessary at this time.
The authors conclude that “best interest or non-maleficence arguments could be used to justify not yielding to Ms. Hollowell’s autonomous request and limiting her access because of the risk of harm from over-treatment as outlined above.”
However, the authors continue, “in the current environment, in which mammograms are considered standard of care, Dr. Perry would be incurring significant personal liability were Ms. Hollowell to be diagnosed with breast cancer at a later stage.”
So, too in end-of-life medicine. The standard of care is not aligned with best practices. It is unfortunate that what is legally safe is “bad” medicine, while practicing “good” medicine is legally risky.
I used to take my son to the La Brea tar pits a few blocks from where we used to live. The prevailing standard of care is like the tar pits that are trapping saber tooth clinicians trying to break free.