When Should Countervailing Considerations Override a Non-Beneficial Treatment Policy?

Abstract: Many hospitals have non-beneficial treatment (NBT) policies designed to empower clinicians to withhold or withdraw interventions deemed medically futile. These policies are rooted in the goal of protecting patients from unnecessary harm, suffering, and indignity while maintaining professional integrity. However, when enforced against the objections of family members, these policies can lead to intense conflict, reputational damage, and even institutional hesitancy, with some hospitals becoming reluctant to apply the policy in the future.
In this presentation, I will explore the ethical and practical tensions involved in enforcing NBT policies, especially when doing so could have broader institutional consequences. Specifically, I will examine the countervailing considerations—such as public back lash, staff well-being, or the long-term viability of the policy—that may justify not pursing the non-beneficial treatment policy, even when it goes against the immediate interests of the patient. The literature, although cognizant of this problem, offers little guidance on how to navigate these complex issues, leaving institutions uncertain about how to balance these competing concerns.
Through a combination of real-world cases and ethical analysis, I will explore when it might be necessary to step back from or slow down enforcing an NBT policy. I will also discuss practical recommendations for how institutions can navigate these situations, maintaining their commitment to patient-centered care while acknowledging the practical realities of institutional risk management.

Keywords: Non-beneficial treatment policy, End-of-life decision making, Public perception