Medical futility at the end of life: the perspectives of intensive care and palliative care clinicians

Journal of Medical Ethics
R J JoxGian Domenico Borasio

Abstract

Medical futility at the end of life is a growing challenge to medicine. The goals of the authors were to elucidate how clinicians define futility, when they perceive life-sustaining treatment (LST) to be futile, how they communicate this situation and why LST is sometimes continued despite being recognised as futile. The authors reviewed ethics case consultation protocols and conducted semi-structured interviews with 18 physicians and 11 nurses from adult intensive and palliative care units at a tertiary hospital in Germany. The transcripts were subjected to qualitative content analysis. Futility was identified in the majority of case consultations. Interviewees associated futility with the failure to achieve goals of care that offer a benefit to the patient's quality of life and are proportionate to the risks, harms and costs. Prototypic examples mentioned are situations of irreversible dependence on LST, advanced metastatic malignancies and extensive brain injury. Participants agreed that futility should be assessed by physicians after consultation with the care team. Intensivists favoured an indirect and stepwise disclosure of the prognosis. Palliative care clinicians focused on a candid and empathetic information strategy. ...Continue Reading

Citations

Mar 7, 2014·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·E Muhl
Jan 23, 2014·Journal of General Internal Medicine·F Amos BaileyKathryn L Burgio
Nov 6, 2013·Nature Reviews. Cardiology·Susanna Price, Elizabeth Haxby
Nov 19, 2014·Critical Care : the Official Journal of the Critical Care Forum·Mieke VisserDirk Houttekier
May 9, 2014·Critical Care Medicine·Thanh N HuynhNeil S Wenger
Dec 4, 2015·Holistic Nursing Practice·Maryam Aghabarary, Nahid Dehghan Nayeri
Jan 27, 2015·HEC Forum : an Interdisciplinary Journal on Hospitals' Ethical and Legal Issues·Philip M Rosoff
Jun 30, 2016·International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care·M Cardona-MorrellK Hillman
Mar 29, 2014·Lancet Neurology·Marjolein GeurtsH Bart van der Worp
May 18, 2016·Journal of Medical Ethics·Lindy WillmottEliana Close
Mar 24, 2016·Nursing Ethics·Maryam Aghabarary, Nahid Dehghan Nayeri
Jul 23, 2015·Journal of Applied Gerontology : the Official Journal of the Southern Gerontological Society·Minnie BluhmMaria Silveira
Feb 6, 2016·Palliative Medicine·Julia Desiree LotzMonika Führer
Jan 9, 2014·The American Journal of Hospice & Palliative Care·Vasco Moscovici da CruzPedro Caruso
Jan 1, 2016·The American Journal of Hospice & Palliative Care·Eluned MunCraig Nakatsuka
Sep 19, 2019·Revista brasileira de enfermagem·Karen Gisela Moraes ZepedaLiana Amorim Corrêa Trotte
Dec 12, 2019·Hospital Practice·Wil L SantivasiKevin J Whitford
Oct 11, 2017·The Journal of Nursing Research : JNR·Ming-Yi HsuYu-Chen Chen
Nov 7, 2019·Turkish Journal of Emergency Medicine·Guillaume EconomosElise Perceau-Chambard
Jun 22, 2017·Journal of Bioethical Inquiry·Lenko ŠarićMarko Jukić
Jul 8, 2020·The American Journal of Hospice & Palliative Care·Anthony MilkiJohn K Chan
Oct 23, 2014·Medical Science Monitor : International Medical Journal of Experimental and Clinical Research·Urh GroseljStefan Grosek
Jan 27, 2019·Internal Medicine Journal·Bharathy GunasekaranJennifer Weil
May 31, 2019·European Journal of Cancer Care·Matthias UnseldEva Katharina Masel
Sep 1, 2018·Joint Commission Journal on Quality and Patient Safety·Magnolia CardonaKen Hillman
Sep 22, 2020·British Journal of Anaesthesia·Douglas H BlackwoodDavid Walker
Jul 14, 2021·Journal of Medical Ethics·Mayli MertensMarianne Boenink

❮ Previous
Next ❯

Related Concepts

Related Feeds

Brain Injury & Trauma

brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.