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Related Experiment Videos

Futility: a concept in evolution.

Jeffrey P Burns1, Robert D Truog

  • 1Division of Critical Care Medicine, Department of Anesthesia, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.

Chest
|December 15, 2007
PubMed
Summary
This summary is machine-generated.

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Resolving disputes over futile medical treatment requires a shift from rigid definitions and hospital-based procedures. The future lies in bedside communication and negotiation, with clinician support for difficult cases.

Area of Science:

  • Medical Ethics
  • Clinical Decision-Making
  • Patient-Family Relations

Background:

  • The management of futile medical treatment cases has evolved over two decades.
  • Previous approaches focused on defining futility or using hospital ethics committees, but these have proven unsuccessful due to lack of societal consensus on treatment benefits.

Purpose of the Study:

  • To analyze the evolution of approaches to resolving futile treatment disputes.
  • To propose a new paradigm for managing these complex ethical and clinical challenges.

Main Methods:

  • Historical analysis of the three generations of futility debate.
  • Proposal of a communication and negotiation-based paradigm.

Main Results:

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  • First-generation attempts to define futility failed due to subjective value judgments.
  • Second-generation procedural approaches also failed due to lack of consensus on beneficial treatments.
  • A third-generation approach focusing on bedside communication and negotiation is proposed.

    • Conclusions:

    • Future resolution of futile treatment disputes should prioritize communication and negotiation at the bedside.
    • In intractable cases, clinicians should focus on mutual support rather than overriding patient/family demands.