The Standard of Care Retards Improvement

This article by Daniel Merenstein in the January 2004 JAMA nicely illustrates the limits to most statutory safe harbors to refuse inappropriate end-of-life medicine.  The safe harbors are linked to and contingent upon standard of care.  But the standard of care is often to provide aggressive end-of-life treatment.  The legal definition of standard of care protects the continued use of outdated protocols.  As Merenstein writes:  "In our legal system, the physicians who are slow to change are the winners."