Defensive Medicine Like Crossing a Mine Field

When it comes to end-of-life treatment disputes, clinicians often think that they must cross a legal "mine field" to get to the appropriate medical course of action.  Let's use this metaphor to explore the resolution of intractable end-of-life treatment conflicts.



To be precise, clinicians not only believe that there is a legal mine field, they also think the field is heavily mined, such that there is a very good chance they will be blown up.  In fact, the field is very lightly mined.  Clinicians could cross the field repeatedly without triggering any mines.  



Nevertheless, that clarification is understandably of little comfort. To permit clinicians to practice what they judge appropriate medicine, we need to reassure them that it is "safe" to cross the mine field.  It is insufficient to say "there aren't too many mines."  We need to either (a) confirm that there are zero mines or at least (b) mark where the mines are so they can be avoided.  



Doing the latter is analogous to the legislation of legal safe harbor immunity.  So long as clinicians follow a certain "path," they will not get blown up.  But what path should be required?  How much deference do we want to accord to the profession?  How much oversight and accountability do we want to retain?  How much can we retain without introducing more mines?  This is my project.