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Addressing Futility: A Practical Approach.

Piroska K Kopar1, Adrienne Visani1, Kyler Squirrell1

  • 1All authors: CHESS: Center for Humanism and Ethics in Surgical Specialties, Department of Surgery, Washington University School of Medicine in Saint Louis, Saint Louis, MO.

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|July 11, 2022
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Summary
This summary is machine-generated.

Setting limits on nonbeneficial medical care is ethically vital but challenging. Defining medical futility based on patient goals aids clinicians in providing ethical, goal-aligned critical care.

Keywords:
end-of-life careethics at the end of lifefutilitygoals-of-carenonbeneficial care

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Area of Science:

  • Medical Ethics
  • Critical Care Medicine
  • Palliative Care

Background:

  • Limiting nonbeneficial medical care is ethically recommended in critical care.
  • Practically implementing treatment limitations presents significant challenges for clinicians.

Purpose of the Study:

  • To identify best practices for defining medical futility.
  • To use futility as an anchoring concept for ethical decision-making in Intensive Care Units (ICUs).

Main Methods:

  • A PubMed literature review was conducted.
  • English language articles on medical futility, end-of-life care, and communication strategies were selected.
  • Authors evaluated articles for recurrent themes and reached a consensus.

Main Results:

  • Continued life-sustaining treatment may conflict with patient goals if unlikely to yield meaningful benefit.
  • Clinician comfort in limiting futile care is influenced by institutional norms, biases, and conflict navigation difficulties.
  • Defining futility by patient goals, focusing on outcomes, and proactive family communication are key to meaningful critical care.

Conclusions:

  • Clinicians have an ethical duty to avoid providing futile care.
  • Understanding futility is crucial for ethical practice.
  • ICU discussions should focus on eliciting patient values, aligning interventions with goals, and offering only beneficial treatments.