The Abuse of Futility

Schneiderman, Lawrence J.; Jecker, Nancy S.; Jonsen, Albert R.

doi:10.1353/pbm.2018.0001

Cited by 32 publications

(5 citation statements)

References 19 publications

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“…Semantics matter (21) but our current vocabulary does not facilitate a clear understanding of the topic. Furthermore, as some bioethicists have claimed, the recommended change in terminology from futile to potentially inappropriate may have only made it more difficult for community stakeholders to grasp (22). As such, before bringing the public to the table in a dialogue that will shape policy and legislation, the lay public needs to be educated about the issues that come into play in situations regarding potentially inappropriate treatment.…”

Section: Original Research Discussionmentioning

confidence: 99%

The Community Perspective on Potentially Inappropriate Treatment

Neville¹,

Tarn²,

Pavlish³

et al. 2020

Annals ATS

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Rationale: Medical interventions that prolong life without achieving an effect that the patient can appreciate as a benefit are often considered futile or inappropriate by healthcare providers. In recent years, a multicenter guideline has been released with recommendations on how to resolve conflicts between families and clinicians in these situations and to increase public engagement. Although laypeople are acknowledged as important stakeholders, their perceptions and understanding of the terms "potentially inappropriate" or "futile" treatment have received little formal evaluation.Objectives: To evaluate the community perspective about the meaning of futile treatment.Methods: Six focus groups (two groups each of ages ,65, 65-75, and .75 yr) were convened to explore what constitutes futile treatment and who should decide in situations of conflict between doctors and families. Focus group discussions were analyzed using grounded theory.Results: There were 39 participants aged 18 or older with at least one previous hospitalization (personal or by immediate relative). When asked to describe futile or inappropriate treatment, community members found the concept difficult to understand and the terminology inadequate, though when presented with a case describing inappropriate treatment, most participants recognized it as the provision of inappropriate treatment. Several themes emerged regarding participant difficulty with the concept, including inadequate physician-patient communication, lack of public emphasis on end-of-life issues, skepticism that medical treatment can be completely inappropriate, and doubts and fears that medical futility could undermine patient and/or family autonomy. Participants also firmly believed that in situations of conflict families should be the ultimate decision-makers.Conclusions: Public engagement in policy development and discourse around medical futility will first require intense education to familiarize the lay public about use of inappropriate treatment at the end of life.

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Section: Original Research Discussionmentioning

confidence: 99%

The Community Perspective on Potentially Inappropriate Treatment

Neville¹,

Tarn²,

Pavlish³

et al. 2020

Annals ATS

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“…Other definitions suggest physiologic futility. 72 – 74 It suggests a definite shift, not the uncertainty characteristic of critical illness trajectory. 72 To the patient, the word may convey a sense of failure, hopelessness, abandonment, or even “worthlessness.” 75…”

Section: R Esultsmentioning

confidence: 99%

Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit

Gupta,

Kumar,

Mathur

et al. 2024

Indian Journal of Critical Care Medicine

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End-of-life care (EOLC) exemplifies the joint mission of intensive and palliative care (PC) in their human-centeredness. The explosion of technological advances in medicine must be balanced with the culture of holistic care. Inevitably, it brings together the science and the art of medicine in their full expression. High-quality EOLC in the ICU is grounded in evidence, ethical principles, and professionalism within the framework of the Law. Expert professional statements over the last two decades in India were developed while the law was evolving. Recent landmark Supreme Court judgments have necessitated a review of the clinical pathway for EOLC outlined in the previous statements. Much empirical and interventional evidence has accumulated since the position statement in 2014. This iteration of the joint Indian Society of Critical Care Medicine–Indian Association of Palliative Care (ISCCM–IAPC) Position Statement for EOLC combines contemporary evidence, ethics, and law for decision support by the bedside in Indian ICUs. How to cite this article Mani RK, Bhatnagar S, Butola S, Gursahani R, Mehta D, Simha S, et al . Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit. Indian J Crit Care Med 2024;28(3):200–250.

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“…This perspective was selected to allow for more objective assessment of both prognostic information, especially in the context of neurologic injury (8), and action on the parts of the physicians and the family members discussed in the vignette. Although the definition of medical "futility" and the appropriate terminology remains a point of contention (9), we used the definition of "potentially inappropriate" laid out in the American Thoracic Society position statement (5) in designing our survey.…”

Section: Survey Designmentioning

confidence: 99%

Explaining the Process of Determining Futility Increases Lay Public Acceptance

Bailoor¹,

Valley²,

Kukora

et al. 2019

Annals ATS

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Rationale: National guidelines have laid out a process to conflict resolution in cases of potentially inappropriate medical interventions.Objectives: To determine the association between information about a process-based approach and lay public perceptions of the appropriateness of withholding medically inappropriate interventions.Methods: Respondents from a nationwide sample completed a survey with two adult intensive care unit-based vignettes: one about advanced cancer where doctors told the family that additional chemotherapy would not be offered, and a second case of multiorgan failure after brain hemorrhage where dialysis would not be offered. Participants were randomly assigned to see or not see information about a detailed process for the determination to withhold (second opinion, ethics consultation, exploring transfer to another institution). The primary outcome was the perceived appropriateness of not providing the treatment (four-point scale, dichotomized for analysis, modified Poisson regression), and the secondary outcome was the negative emotional reaction to the case (positive and negative affect schedule, range 1-5, higher is greater negative emotional response, linear regression).Results: A total of 1,191 respondents were included. Providing detailed process information increased the perceived appropriateness of withholding treatment by approximately 10 percentage points in each vignette: (chemotherapy, 75.7-85.4%; dialysis, 68.0-79.3%). Process information remained associated with perceived appropriateness of withholding treatment after adjustment for order effects and prespecified respondent characteristics (chemotherapy: prevalence ratio, 1.13; 95% confidence interval [CI], 1.07-1.19) (dialysis: prevalence ratio, 1.17; 95% CI, 1.10-1.25). Process information was not associated with emotional response to the cases (chemotherapy: b = 20.04; 95% CI, 20.16 to 0.09) (dialysis: b = 20.02; 95% CI, 20.14 to 0.10; both adjusted for order effects).Conclusions: Providing process-based conflict resolution information increased public acceptance of determinations of medical futility, supporting the practice outlined in national consensus statements.

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The Abuse of Futility

Cited by 32 publications

References 19 publications

The Community Perspective on Potentially Inappropriate Treatment

The Community Perspective on Potentially Inappropriate Treatment

Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit

Explaining the Process of Determining Futility Increases Lay Public Acceptance

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