Judging Who Should Live: Schneiderman and Jecker on the Duty Not to Treat.

William Harper, Judging Who Should Live: Schneiderman and Jecker on the Duty Not to Treat, 23 J. MED. & PHIL. 500 (1998).

In Wrong Medicine, Lawrence J. Schneiderman and Nancy S. Jecker conclude that any treatment for a patient who "lacks the capacity to appreciate the benefit of a treatment" or who is not expected ever to be freed from total dependence on an ICU, should be forbidden. The ban would not include pain killers or other comfort care for the patient. Thus, according to Schneiderman and Jecker, even a patient who is conscious and wants to live longer should be denied treatments that would successfully effect those ends if such treatments would not lead to temporary release from the ICU. Since feeding intubation has been ruled a treatment (Cruzan v. Director, Missouri Dept. of Health, 1990), it would also follow that the feeding and hydration of permanently comatose patients would be forbidden. Schneiderman and Jecker characterize treatments that do not achieve these minimum goals as "futile." It is with such an understanding of futility that they claim that certain popular assumptions must be "examined anew in order to make room for the idea of medical futility." The futility of a treatment is independent of the availability of resources, and concerns only what is in the best interest of the individual patient.

Schneiderman and Jecker recognize that CPR can keep a dying patient alive longer, but deny that living longer benefits a patient who is permanently and totally dependent on intensive care. The roots of Schneiderman and Jecker's intuitions about medical benefit lie in a belief that an ability to pursue life goals is essential to having a life worth preserving. Not just any life goals will do.

Schneiderman and Jecker are assuming that the pursuit of certain goals--beyond the goal merely of staying alive--is what makes a life worth living and worth preserving. Positions other than Schneiderman and Jecker's on life goals are possible. One might hold that a worthwhile life lies in doing the will of God. This would imply that issues of personal pain, pleasure, and the achievement of other life goals are secondary matters. Some people may hold, as the Pythagoreans did, that life is a post to be held at all costs. Such a position implies that life saving treatments are beneficial even if extremely painful. Hedonists hold that a worthwhile life consists in pleasurable experiences, implying that a life of great suffering is not...