Medical futility at the end of life: the perspectives of intensive care and palliative care clinicians
Graduate studies at Western
Journal of Medical Ethics 38 (9):540-545 (2012)
|Abstract||Objectives Medical futility at the end of life is a growing challenge to medicine. The goals of the authors were to elucidate how clinicians define futility, when they perceive life-sustaining treatment (LST) to be futile, how they communicate this situation and why LST is sometimes continued despite being recognised as futile. Methods The authors reviewed ethics case consultation protocols and conducted semi-structured interviews with 18 physicians and 11 nurses from adult intensive and palliative care units at a tertiary hospital in Germany. The transcripts were subjected to qualitative content analysis. Results Futility was identified in the majority of case consultations. Interviewees associated futility with the failure to achieve goals of care that offer a benefit to the patient's quality of life and are proportionate to the risks, harms and costs. Prototypic examples mentioned are situations of irreversible dependence on LST, advanced metastatic malignancies and extensive brain injury. Participants agreed that futility should be assessed by physicians after consultation with the care team. Intensivists favoured an indirect and stepwise disclosure of the prognosis. Palliative care clinicians focused on a candid and empathetic information strategy. The reasons for continuing futile LST are primarily emotional, such as guilt, grief, fear of legal consequences and concerns about the family's reaction. Other obstacles are organisational routines, insufficient legal and palliative knowledge and treatment requests by patients or families. Conclusion Managing futility could be improved by communication training, knowledge transfer, organisational improvements and emotional and ethical support systems. The authors propose an algorithm for end-of-life decision making focusing on goals of treatment|
|Keywords||No keywords specified (fix it)|
|Categories||categorize this paper)|
|Through your library||Configure|
Similar books and articles
H. ten Have & David Clark (eds.) (2002). The Ethics of Palliative Care: European Perspectives. Open University Press.
Mary Ann Baily (2011). Futility, Autonomy, and Cost in End-of-Life Care. Journal of Law, Medicine and Ethics 39 (2):172-182.
Michael Ashby (2011). The Futility of Futility: Death Causation is the 'Elephant in the Room' in Discussions About Limitation of Medical Treatment. [REVIEW] Journal of Bioethical Inquiry 8 (2):151-154.
Y. Tony Yang & Margaret M. Mahon (2012). Palliative Care for the Terminally Ill in America: The Consideration of QALYs, Costs, and Ethical Issues. [REVIEW] Medicine, Health Care and Philosophy 15 (4):411-416.
Laura Hawryluck, William Harvey, Louise Lemieux-Charles & Peter Singer (2002). Consensus Guidelines on Analgesia and Sedation in Dying Intensive Care Unit Patients. BMC Medical Ethics 3 (1):1-9.
John C. Moskop (1995). From Futility to Triage. Journal of Medicine and Philosophy 20 (2):191-205.
Fiona Randall (2006). The Philosophy of Palliative Care: Critique and Reconstruction. Oxford University Press.
Timothy E. Quill (2012). Physicians Should “Assist in Suicide” When It Is Appropriate. Journal of Law, Medicine and Ethics 40 (1):57-65.
Charles Weijer, Peter A. Singer, Bernard M. Dickens & Stephen Workman, Bioethics for Clinicians: 16. Dealing with Demands for Inappropriate Treatment.
Douglas N. Walton (1983). Ethics of Withdrawal of Life-Support Systems: Case Studies on Decision-Making in Intensive Care. Greenwood Press.
H. Colby William, John Lantos Constance Dahlin & Myra Christopher John Carney (forthcoming). The National Consensus Project for Quality Palliative Care Clinical Practice Guidelines Domain 8: Ethical and Legal Aspects of Care. HEC Forum.
William Colby, Constance Dahlin, John Lantos, John Carney & Myra Christopher (2010). The National Consensus Project for Quality Palliative Care Clinical Practice Guidelines Domain 8: Ethical and Legal Aspects of Care. [REVIEW] HEC Forum 22 (2):117-131.
Rosemarie Tong (1995). Towards a Just, Courageous, and Honest Resolution of the Futility Debate. Journal of Medicine and Philosophy 20 (2):165-189.
Fiona Randall (1996). Palliative Care Ethics: A Good Companion. Oxford University Press.
Added to index2012-05-06
Total downloads4 ( #189,051 of 739,319 )
Recent downloads (6 months)1 ( #61,243 of 739,319 )
How can I increase my downloads?