Futility and appropriateness: challenging words, important concepts

Postgraduate Medical Journal
D Robin Taylor, Calvin J Lightbody

Abstract

The provision of healthcare is being challenged by a 'perfect storm' of forces including an increasing population with multiple comorbidities, high expectations and resource limitations, and in the background, the pre-eminence of the 'curative medical model'. Non-beneficial (futile) treatments are wasteful and costly. They have a negative impact on quality of life especially in the last year of life. Among professionals, frequent encounters with futility cause moral distress and demoralisation. The factors that drive non-beneficial treatments include personal biases, patient-related pressures and institutional imperatives. Breaking loose from the perceived necessity to deliver non-beneficial treatment is a major challenge. Curative intent should give way to appropriateness such that curative and palliative interventions are valued equally. Goals of treatment should be shaped by illness trajectory, the risk of harms as well as potential benefits and patient preferences. This strategy should be reflected in professional training and the design of acute services.

References

Oct 20, 2001·The Journal of Law, Medicine & Ethics : a Journal of the American Society of Law, Medicine & Ethics·Ann Alpers, Bernard Lo
Apr 16, 2002·BMJ : British Medical Journal·David Clark
Apr 30, 2005·BMJ : British Medical Journal·Scott A MurrayAziz Sheikh
Dec 7, 2007·Quality & Safety in Health Care·Ali Baba-Akbari SariAileen Richardson
Dec 17, 2008·Annals of Internal Medicine·Latifat ApatiraDouglas B White
Mar 11, 2009·Archives of Internal Medicine·Baohui ZhangHolly G Prigerson
Jun 10, 2011·BMJ : British Medical Journal·Richard L PrinceJoshua R Lewis
Aug 2, 2011·Harm Reduction Journal·Brad Rodu
Dec 29, 2011·JAMA : the Journal of the American Medical Association·Ruth D PiersUNKNOWN APPROPRICUS Study Group of the Ethics Section of the ESICM
May 4, 2012·The New England Journal of Medicine·Howard Brody
May 24, 2012·Journal of General Internal Medicine·Glyn ElwynMichael Barry
Jun 30, 2012·The Journal of Trauma and Acute Care Surgery·Ross J FleischmanCraig D Newgard
Jul 17, 2012·The American Journal of Hospice & Palliative Care·Monika RenzFlorian Strasser
Aug 9, 2012·Current Opinion in Supportive and Palliative Care·Maren GalushkoRaymond Voltz
Sep 5, 2012·Archives of Internal Medicine·David W Kissane
Nov 21, 2012·The Medical Journal of Australia·Adam G ElshaugCameron D Willis
Jun 28, 2013·The New England Journal of Medicine·Alexander K SmithRobert M Arnold
Jul 19, 2013·Journal of Patient Safety·John T James
Jul 23, 2013·BMJ Quality & Safety·Allen HutchinsonPeter A Bath
Mar 19, 2014·Palliative Medicine·David ClarkChristopher Isles
May 9, 2014·Critical Care Medicine·Thanh N HuynhNeil S Wenger
Jul 8, 2014·The Journal of the Royal College of Physicians of Edinburgh·P A Levack
Jul 22, 2014·International Journal of Palliative Nursing·Tami BornemanMihaela Cristea
Jul 2, 2015·The Australian Journal of Rural Health·Kirsten AuretSharon Evans
Sep 24, 2015·Journal of General Internal Medicine·Elizabeth DzengThomas J Smith
Jan 20, 2016·JAMA : the Journal of the American Medical Association·Joel S WeissmanHolly G Prigerson
Apr 30, 2016·The Medical Journal of Australia·Ben WhiteLeonie K Callaway
May 18, 2016·Journal of Medical Ethics·Lindy WillmottEliana Close
Jun 5, 2016·European Journal of Anaesthesiology·Rosaleen Macfadyen, Paul C McConnell
Jun 18, 2016·Perioperative Medicine·Ramai Santhirapala, Ramani Moonesinghe
Jun 30, 2016·International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care·M Cardona-MorrellK Hillman
Nov 3, 2016·The New England Journal of Medicine·Arabella L Simpkin, Richard M Schwartzstein
Nov 5, 2016·BMC Medical Informatics and Decision Making·Gustavo SaposnikPhilippe N Tobler
Jan 13, 2017·Lancet·Shannon BrownleeDeborah Korenstein
Mar 2, 2017·BMJ : British Medical Journal·Zoë FritzGavin D Perkins
Jul 21, 2017·The New England Journal of Medicine·Margaret L Schwarze, Lauren J Taylor

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Citations

Dec 10, 2019·Current Opinion in Supportive and Palliative Care·Massimo Romanò
Mar 19, 2020·International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care·D Robin TaylorCalvin J Lightbody
Sep 7, 2018·Journal of Hospice and Palliative Nursing : JHPN : the Official Journal of the Hospice and Palliative Nurses Association·Margaret M Mahon, Karen L Barker
Nov 20, 2020·International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care·Janet BouttellDouglas Robin Taylor
Mar 1, 2021·Pulmonology·Joana Branco, Isabel Galriça Neto

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