Resolution of futility by due process: early experience with the Texas Advance Directives Act.

Medical futility and the Texas Advance Directives Act of 1999.

Futility: the limits of mediation.

In a recent issue of CHEST (December 2007), Burns and Truog1 argued that the history of futility can be divided into the following three sequential periods: the definitional approach; the procedural approach; and the conflict resolution approach. We agree that attempts to define futility have failed, and we agree that the procedural approach of the Texas Advance Directives Act fails to accord n...

Issues surrounding end-of-life decision-making

End-of-life decision-making is a complex process that can be extremely challenging. We describe a 42-year-old woman in an irreversible coma without an advance directive. The case serves to illustrate the complications that can occur in end-of-life decision-making and challenges in resolving difficult futility disputes. We review the role of advance directives in planning end-of-life care, the r...

Tackling medical futility in Texas.

n engl j med 357;1 www.nejm.org july 5, 2007 was an 18-month-old boy who had Leigh’s disease, a progressive and fatal neurometabolic disorder. He had been on life support in the intensive care unit for 5 months. The hospital had invoked the Texas Advance Directives Act, which authorized it to withdraw life support if an ethics committee had determined that further life support was medically ina...

The Australian experience of advance directives and possible future directions

This paper analyses the role that advance directives can play in the formation of advanced care planning. Following on from a review of the legal history of advance directives in Australia, including the common law and statutory regimes, it is argued that schemes for advance directives have not yet proven to be successful. It is proposed that what is needed is a more integrated approach, whereb...