Medical futility in psychiatry: a qualitative systematic review protocol

The objective of this systematic review will be to synthesize the experiences and perceptions of patients and mental health professionals regarding medical futility in psychiatric care. Specifically, the review will aim to clarify which practices are considered futile, as well as the ethical, relational, and contextual factors shaping these judgments.

Although extensively discussed in general medicine, futility in psychiatric care-often termed psychiatric or medical futility-remains underexplored and controversial. In psychiatry, considerations of futility involve complex ethical tensions related to chronicity, treatment resistance, autonomy, and shifting therapeutic goals.

We will include qualitative studies that explore perceptions, experiences, or ethical reasoning related to psychiatric futility. Eligible studies must focus on individuals with severe mental illness or mental health professionals involved in clinical decision-making in mental health care.

This review will follow the JBI methodology for systematic reviews of qualitative evidence. The review will be reported in accordance with PRISMA guidelines. The search strategy will be applied across 6 databases: PubMed, Embase (Ovid), Scopus, Web of Science Core Collection, PsycINFO (EBSCOhost), and CINAHL (EBSCOhost). No language or date restrictions will be applied. The findings will be synthesized using meta-aggregation, and confidence in the synthesized results will be assessed using the ConQual approach.

PROSPERO CRD42025643549.