Addressing 'futility' in psychiatry: a consensus statement

Area of Science:

• Psychiatry
• Medical Ethics
• Philosophy of Medicine

Background:

• Futility is a concept widely used in somatic medicine but underexplored in psychiatry.
• Limited ethical guidelines exist for making futility judgments in mental healthcare.

Purpose of the Study:

• To describe futility in psychiatry and develop ethical guidelines for futility judgments.
• To examine the applicability of somatic medicine futility concepts to psychiatric care.

Main Methods:

• International, multidisciplinary workshop with clinicians, ethicists, philosophers, patient advocates, and persons with lived experience.
• Analysis of physiological, quantitative, and qualitative futility concepts.
• Discussion on authority, process, and patient-centeredness in futility assessments.

Main Results:

• Qualitative futility appears most applicable to psychiatric care.
• Consideration of psychiatric futility in relation to terminal mental illness and recovery is necessary.
• Key considerations include who makes judgments, the evaluation process, and alignment with patient goals.

Conclusions:

• Psychiatric futility is a potentially useful concept for mental healthcare.
• Potential benefits include reduced harmful treatments and reevaluation of care goals.
• Ethical limits and potential risks, such as psychological harm, must be addressed.