Evaluating a patient's request for life-prolonging treatment: an ethical framework

Area of Science:

• Medical Ethics
• Palliative Care
• Healthcare Decision-Making

Background:

• While patient preferences for palliative care are often respected, challenging ethical dilemmas arise when competent patients request life-prolonging treatments that physicians deem futile.
• Physicians have historically used the concept of futility to justify unilaterally withholding or withdrawing life-sustaining treatments.
• Neither patient autonomy nor the concept of futility alone adequately resolves conflicts regarding treatment requests at the end of life.

Purpose of the Study:

• To propose an ethical algorithm to systematically address patient requests for treatments considered futile by physicians.
• To integrate arguments from academic discussions on futile treatment into a practical decision-making framework.
• To improve ethical decision-making processes involving physicians, patients, and families at the end of life.

Main Methods:

• Development of a five-guiding-question ethical algorithm for evaluating patient treatment requests.
• The algorithm assesses treatment effectiveness, benefit-harm ratio, patient understanding, patient preference, and resource utilization.
• This structured approach aims to provide substantive considerations beyond current procedural conflict resolution methods.

Main Results:

• The proposed algorithm provides a systematic method for physicians to approach and respond to patient requests for potentially futile treatments.
• It facilitates a more ethically appropriate and structured response compared to relying solely on futility or autonomy arguments.
• The algorithm aids in improving shared decision-making among physicians, patients, and families.

Conclusions:

• An ethical algorithm integrating multiple considerations is essential for navigating complex end-of-life treatment decisions.
• This framework supports ethically sound responses to patient-initiated requests for life-prolonging interventions.
• The algorithm enhances the quality of decision-making in ethically challenging healthcare situations.