The illusion of futility in clinical practice☆

Lantos, John D.; Сингер, Петер; Walker, R. M.; Gramelspacher, Gregory P.; Shapiro, Gary R.; Sánchez-González, Miguel Ángel; Stocking, Carol; Miles, Steven; Siegler, Mark

doi:10.1016/0002-9343(89)90542-1

Cited by 46 publications

(47 citation statements)

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“…The issues confronting the physician are whether such techniques should be applied to all patients with terminal malignancies and, if they are applied, when such interventions should be withdrawn. [1][2][3][4][5][6] The role of the physician in end-of-life decision-making is complicated. One extreme is the situation in which the physician aims for prolongation of life for patients with terminal disease by using all available life-sustaining measures, regardless of whether such measures will improve the patient's condition.…”

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confidence: 99%

Discrepancies among patients, family members, and physicians in Korea in terms of values regarding the withholding of treatment from patients with terminal malignancies

Kim

Lee

et al. 2004

Cancer

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BACKGROUND The role of the physician in end‐of‐life decision‐making is complicated. To analyze the controversies that surround therapeutic decision‐making and the withholding of life‐sustaining treatments, the authors compared values regarding therapeutic intervention that were held by physicians and family members of patients with terminal malignancies. METHODS One hundred fourteen patients with either advanced‐stage or terminal disease were enrolled in the current study. Questionnaires were administered to the duty physician and to patients' family members. The questions covered issues such as the use of new anticancer agents with only partial efficacy (15%) and the use of opioid analgesics, intravenous nutrition, feeding tubes, antibiotics, and hemodialysis. In addition, participants were asked about the administration of cardiopulmonary resuscitation (CPR) and the use of ventilators, and when the patient's family consented, the same questionnaire was administered to the patient as well. RESULTS Seventeen of 114 families refused to answer the questionnaire. Of the 97 available families, only 14 permitted access to the patient. Of those 14 patients, 5 refused to complete the questionnaire. Overall, 100% of families and 87% of patients had some knowledge regarding malignant disease, but only 69% of families and 37% of patients clearly understood the stage of the patient's disease. The use of a new agent with only partial efficacy (≈ 15%) was accepted by 41% of physicians and by 60% of families. The concordance rate between patients' physicians and family members regarding the same patient was 42%. The rankings of the acceptance of treatment by physicians were as follows: opioid analgesics, 100%; antibiotics, 91%; feeding tube, 87%; and intravenous nutrition, 78%. The rankings of the same items by family members were as follows: opioid analgesics, 92%; antibiotics, 89%; intravenous nutrition, 86%; and feeding tube, 75%. The concordance rates between patients' physicians and families were lowest for ventilator application (39%) and CPR (47%). CONCLUSIONS Values held on issues such as therapeutic decision‐making and the withholding of life‐sustaining treatment for patients with terminal malignancies were discordant between physicians and family members. To resolve controversies regarding the role of the physician in end‐of‐life decision‐making, the values of physicians, patients, and family members should be considered in the final decision‐making process. Cancer 2004. © 2004 American Cancer Society.

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confidence: 99%

Discrepancies among patients, family members, and physicians in Korea in terms of values regarding the withholding of treatment from patients with terminal malignancies

Kim

Lee

et al. 2004

Cancer

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“…While in the past major public policy statements have supported the right of a physician to decide to withhold inappropriate treatment on the basis of medical futility [27], a precise definition of futility is elusive. There is no agreement regarding the odds of failure required for a treatment to be considered futile and any "cut-off" is inherently arbitrary [28,29]. The issue of futility may be clarified by shifting the perspective to the appropriateness of care [30].…”

Section: Refining Ethics Educational Objectivesmentioning

confidence: 99%

Ethical Issues in Patients with Leukemia: Practice Points and Educational Topics for the Clinical Oncologist and Trainees

Farroni¹,

Thompson²,

Arif³

et al. 2017

J Clin Res Bioeth

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Leukemia represents a complex spectrum of malignancies, involving numerous treatment options and substantial symptom burden for patients. Ethical dilemmas may arise which challenge a physician's clinical management and the patient's goals of care. What is needed is the systematic analysis of the most common issues that confront clinical teams treating patients with leukemia in order to derive best ethical practices for optimized patient care. We examined 312 formal ethics consultations requested for patients with a leukemia diagnosis. We found that the most common ethical issues relate to the level of appropriate intervention, the futility of treatment and surrogate decisionmaking. The underlying causes stem from inadequately addressed psychosocial issues, disagreements between various stakeholders in the patient's care and miscommunication. Illuminating these issues provides areas of focus for the practitioner to refine their practice and inform educational initiatives. The integration of the clinical ethics service into the multidisciplinary team is a mechanism to foster a preventative ethics model and mitigate potential dilemmas.

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“…Schneiderman et al [6] have reported similar sentiments, asserting that the term ''medical futility'' is simply a tool to increase the power of the physician over the patient, and to ''repeal recent hard-gained advances in patient autonomy.'' Lantos et al [7] elegantly outlined the complexities of the shifting ethical obligations of physicians, and presciently cautioned against flippantly using the term ''futile'' and thus abandoning one's patient. Nonetheless, declaring a situation futile, by whatever definition, does not achieve the intended goal.…”

Section: Futility In the Literaturementioning

confidence: 99%