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(More customer reviews)I highly recommend it to healthcare professionals and members of bioethics committees, as well as to others interested in the ethical dilemma that the concept of futility represents.
Rubin argues "that physician unilateral decision making on the basis of futility is a problematic and misguided approach to the challenge of setting appropriate limits in medicine". She believes we have been distracted from the meaningful debate about the underlying ethical conflict concerning fundamental differences in view and interest between patients, their families, and their physicians by mistakenly turning to the concept of futility. By rejecting the language of futility she urges us to argue more forthrightly and precisely about the moral appeals at stake between patients and those responsible for their care.
She begins with an overview of the futility debate followed by a conceptual analysis of the term itself. In her third chapter Rubin defends the popular argument that physicians cannot justify unilateral refusal to provide a certain treatment on the grounds of evaluative futility, or "it just would not be worth it to the patient'In chapter four she serves up a bitter pill to us physicians when she deconstructs our certainty in the concept of physiologic futility. Most of us grew up as positivists in that science seemed to deliver us some true facts to work with in the clinical setting. More frequently we speak of data and evidence with our knowledge claims less robust now. This is as it should be. Rubin applies this shift in the philosophy of science to clinical medicine developing a strong argument against unilateral physician decision making based on the concept of physiologic futility. Her last chapter offers a variety of alternative recommendations for solving ethical dilemmas she believes superior to unilateral physician decision making based on futility.
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"The book is a fine addition to the world of academic medicalethics... Readers... will come away with some of the tools for further debate."-- Publishers Weekly"Susan B. Rubin's splendid new book...offers positive, humane solutions to the frustrations that have given rise to thefutility debate." -- Carl Elliott, Medical HumanitiesReview"Rubin offers a thorough and thought-provoking explorationof the concept of futility as a basis for medical decisions." --Choice"... [the] brilliant analysis found in Rubin's [book]couldn't be more timely.... When Doctors Say No is the most thorough philosophicalrebuttal to be found in the literature of medical futility as the basis forunilateral decisionmaking by physicians." -- Charles Weijer, Canadian MedicalAssociation JournalShould physicians be permitted to unilaterallyrefuse to provide treatment that they deem futile? Even if the patient, or thepatient's family, insists that everything possible must bedone?In this book, philosopher and bioethicist Rubin examinesthis controversial issue. She offers a critique of the concept of medical futilityand the debate surrounding it, and she calls for more public debate about theunderlying issues at stake for all of us -- patients, families, health careproviders, insurers, and society at large.
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