Intensive Care Providers’ Perceptions of Medically Futile Treatment: Focus Group Interviews*

Abstract

This study was designed to examine intensive care providers’ perceptions of medically futile treatment. Focus group interviews were conducted with 18 intensive care physicians in charge of critical care units at tertiary hospitals in Daegu, Gwangju, and Seoul, South Korea. Results are as follow. 1. More than half of the participants opposed the inclusion of persistent vegetative state (PVS) patients in the category of medically futile treatment. 2. And though the distinctions between ordinary and extraordinary treatment, and between the withholding and withdrawal of treatment, were not clinically meaningful in the intensive care units under study, they are nevertheless relevant because of individual religious beliefs and Korean cultural traditions. 3. Since the beliefs and traditions of family members often makes it difficult for a patient to fill out advance directives, we argue that a gradual approach would be useful in choosing advance directives, making those directives optional rather than mandatory. 4. Economic factors also play a crucial role in the decision-making process regarding futile treatment in Korea. These factors were neglected in earlier surveys. Finally, the participants insisted that the physician’s right to make clinical decisions about medically futile treatment should be legislatively guaranteed based on their convictions. Based on the results of this study, we suggest the follow: a) that detailed criteria for medically futile treatments be established; b) that a decision-making process be developed that is culturally, ethically, medically, and legally acceptable; and c) that ethical education be provided to intensive care physicians.

Nurse's, physician's and family member's experiences of withholding or withdrawing life‐sustaining treatment process in an intensive care unit

“…With the family member participants, the studies focused on participants' emotional responses to patients' dying and death (Kim & Kang, 2011; Kim, Kang, et al, 2012; Lee & Shin, 2019). Meanwhile, the study by Kim, Son, et al (2012) aimed to ascertain a shared understanding of treatment futility in order to confirm the necessity for legalisation of WWLT before enforcement. Therefore, whilst the shared meanings between different participant groups were lacking in previous studies, this study integrated the shared understandings of cultural values in order to align with the theoretical analysis of Seale (1998): construction of death, which understood death not as biological but instead as sociological, based on the participant's experiences under cultural variation (Seale, 1998).…”

“…Treatment Decision-making Act (2018) (Kim & Kang, 2011;Kim, Kang, et al, 2012;Kim, Son, et al, 2012;Koh et al, 2017;Lee et al, 2017;Lee & Kim, 2016). Therefore, his research, which explores the experiences of nurses, physicians and family members regarding WWLT in South Korea following the enforcement of the Hospice, Palliative Care and Life-sustaining Treatment Decision-making Act (2018), is timely and appropriate.…”

“…In the South Korean studies, the importance of conversation and doing the right thing in the WWLT process were echoed. Family members consented to DNAR in order to protect the patient from suffering and from undignified life‐sustaining treatment (Kim, Son, et al, 2012; Koh et al, 2017; Lee & Shin, 2019). However, the WWLT decision in the South Korean context has a distinct characteristic due to the extent and type of family member involvement.…”

“…Before the enforcement of the Act, do‐not‐attempt‐resuscitate (DNAR) decisions, which have been called do‐not‐resuscitate (DNR) in South Korea, were expanded to mean withholding life‐sustaining treatment. Some qualitative studies have been conducted to explore experiences of WWLT in South Korea; however, they predate the enforcement of the Hospice, Palliative Care and Life‐sustaining Treatment Decision‐making Act ( 2018 ) (Kim & Kang, 2011; Kim, Kang, et al, 2012; Kim, Son, et al, 2012; Koh et al, 2017; Lee et al, 2017; Lee & Kim, 2016). Therefore, his research, which explores the experiences of nurses, physicians and family members regarding WWLT in South Korea following the enforcement of the Hospice, Palliative Care and Life‐sustaining Treatment Decision‐making Act (2018), is timely and appropriate.…”

Characteristics of life-sustaining treatment decisions: National data analysis in South Korea

“…[12,13] This is in line with previous research that interviewed doctors in intensive-care units to nd that family-led decisions to withdraw and withhold patient treatment were more prevalent than patients' own decisions. [14] Particularly, for elderly patients, the family did not deliberately inform the patient of the medical condition, fearing patients' lack of understanding and weakening of willingness to ght the disease. [15,16] Families play a major role in determining patient treatment as they have key information about patient preferences and values.…”