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Applying futility in psychiatry: a concept whose time has come
Sarah Levitt1,2, Daniel Z Buchman3,4,5,6,7
1Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada sarah.levitt@uhn.ca.
Journal of Medical Ethics
|January 14, 2021
Summary
Futility in medicine, when interventions offer no meaningful benefit, can be applied to severe and persistent mental illness (SPMI). Recognizing futility in SPMI care can shift focus to palliative approaches, not opposing recovery.
Area of Science:
- Medical Ethics
- Psychiatry
- Palliative Care
Background:
- The concept of medical futility has a contested meaning and application since the 1980s.
- There is limited discussion on applying futility in the care of individuals with severe and persistent mental illness (SPMI).
- Futility generally describes situations where interventions offer no meaningful benefit to patients or are deemed to have an unacceptable risk-benefit ratio.
Purpose of the Study:
- To explore the literature on medical futility and its application in psychiatric care.
- To argue for the use of futility in managing severe and persistent mental illness (SPMI).
- To propose that futility can guide a shift towards palliative care in psychiatric practice.
Main Methods:
- Literature review on the concept of medical futility.
- Analysis of arguments supporting the application of futility in SPMI.
- Discussion on the relationship between futility, capacity, and recovery in mental health.
Main Results:
- Futility can be defined as interventions providing no meaningful benefit.
- Arguments for futility in SPMI include its potential terminal nature and dynamic risk-benefit ratio impacting quality of life.
- Patient capacity should not prevent declaring futility; it is not contrary to mental health recovery.
Conclusions:
- Futility is a relevant concept for severe and persistent mental illness (SPMI).
- Recognizing futility can facilitate a necessary shift towards palliative care in psychiatric settings.
- Applying futility does not negate the principles of recovery in mental health.
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