Chest
Ethics in Cardiopulmonary MedicineMotivating Factors in Futile Clinical Interventions
Section snippets
Materials and Methods
In 1995, a formal Bioethics Program was instituted at Cedars-Sinai Medical Center. One of its principal functions has been to encourage, organize, and document bioethical consultations. The patient, the patient's family, or any member of the health-care team may request such consultations. The consultation is performed by a specially trained and specially privileged team consisting of a physician, a nurse, and a social worker. Meetings are held with families and health-care providers in an
Clinical Features
The average age of the patients was 73.5 ± 32 years (mean ± 2 SD). Fifty-seven percent of the patients were female, and the remaining 43% were male. The religious makeup was as follows: Jewish, 43%; Catholic, 15%; no religion, 15%; unknown, 12%; other, 8%; and Protestant, 7%. Fifty-seven percent of the patients were admitted with a degenerative disease process, 21% with an inflammatory process, 16% with a neoplastic disorder, and the remaining 6% were admitted secondary to a traumatic event or
Discussion
Our study is unique in evaluating futile and medically inappropriate care on a practical rather than a theoretical basis. We sought to minimize the ambiguity in the definition of futile or medically inappropriate care by selecting patients who died during the hospital stay without a period of marked improvement. This care is most often given to elderly patients with degenerative disease processes. This is not surprising given that these are the patients most likely to have disorders where the
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Cited by (29)
Perceptions of medical futility in clinical practice – A qualitative systematic review
2018, Journal of Critical CareCitation Excerpt :There is still no generally accepted definition in the literature and no widespread guidelines for healthcare staff. Nevertheless, clinical staff uses the concept of medical futility in their decision-making process [19-22]. Many conflicts occur in clinical routine because there is no universal definition of futility: patients and families may demand ‘to do everything’ [23] even if the clinical staff believe that further therapy is futile, or a physician cannot stop a once begun treatment that the nursing staff wishes to forego [23].
Ten common questions (and their answers) on medical futility
2014, Mayo Clinic ProceedingsCitation Excerpt :Medical research and clinical experience continue to refine best evidence-based practices and how a treatment is viewed as beneficial or not.54 Advances in medications and medical technology have, in many instances, contributed to routine expectations for life prolongation and improvements in the quality and quantity of life among critically ill patients.55 However, not all appealing therapies substantially alter outcomes, and, even among those that eventually prove efficacious, there can be a prolonged learning curve to identify which patients will benefit most from such treatments.
Futility: A concept in evolution
2007, ChestCitation Excerpt :They include provisions for families, as well as clinicians, to object to care they believe to be futile. The “bilateral” nature of the policy is important: one retrospective study of 100 cases of allegedly futile treatment found that families insisted on the treatments in 62% of the cases, whereas clinicians were responsible 37% of the time.10 The policy is invoked only when repeated efforts at consensus have failed, and then is designed to assure that all voices have an opportunity to be heard.