Futility considerations in surgical ethics

Abstract

The topic of futility has been intensely debated in bioethical discourse. Surgical futility encompasses considerations across a continuum of care, from decision-making during initial triage, to the choice to operate or refrain from operating on the critically ill, to withdrawal of life-supporting care. Determinations over futility may result in discord between providers and patients or their families, who might insist that treatment be provided at all costs to sustain life. In this manuscript, we will explore some of the possible sources for and manifestations of these disputes, and describe approaches by which to resolve them. Part I will briefly address some of the reasons that families ask for life-sustaining measures against medical advice in the surgical setting. These include variable determinations of both the quality of life and the inherent value of life (stemming from religious, cultural, and personal beliefs). Part II will detail some general instances in which physicians and surgeons can override requests to provide futile treatment, namely: instances of resource scarcity, interventions which carry a high probability of harm, and those that carry significant moral distress. To conclude, Part III will provide concrete guidelines for navigating futility, making an argument for individual case-based communication models in surgical decision-making.

Futility of Up-Front Resection for Anatomically Resectable Pancreatic Cancer

“…The present study aimed to develop a futility risk model for up-front pancreatectomy using a multi-institutional database of patients with anatomically resectable PDAC. In surgical research, an operation is defined as futile when it is not expected to improve the patient’s health, alleviate their symptoms, or prolong life, and when the potential risks and complications outweigh any anticipated benefit . Specifically, we sought to identify pretreatment variables associated with futile pancreatectomy (defined as an operation resulting in patient death or disease recurrence within 6 months) and develop a web-based tool (MetroPancreas) for individual prognostication.…”

“…In surgical research, an operation is defined as futile when it is not expected to improve the patient's health, alleviate their symptoms, or prolong life, and when the potential risks and complications outweigh any anticipated benefit. 13,14 Specifically, we sought to identify pretreatment variables associated with futile pancreatectomy (defined as an operation resulting in patient death or disease recurrence within 6 months) and develop a web-based tool (MetroPancreas) for individual prognostication. Furthermore, unified criteria were searched to maintain the likelihood of a futile pancreatectomy below a safety threshold, weighted against the chance of not receiving postneoadjuvant resection.…”