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Meaningful futility: requests for resuscitation against medical recommendation
  1. Lucas Vivas1,
  2. Travis Carpenter2,3
  1. 1Internal Medicine, William Osler Health System, Brampton, Ontario, Canada
  2. 2Internal Medicine, Unity Health Toronto, Toronto, Ontario, Canada
  3. 3Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Lucas Vivas, Division of General Internal Medicine, William Osler Health System, Brampton, Ontario, Canada; lucas.vivas{at}outlook.com

Abstract

‘Futility’ is a contentious term that has eluded clear definition, with proposed descriptions either too strict or too vague to encompass the many facets of medical care. Requests for futile care are often surrogates for requests of a more existential character, covering the whole range of personal, emotional, cultural and spiritual needs. Physicians and other practitioners can use requests for futile care as a valuable opportunity to connect with their patients at a deeper level than the mere biomedical diagnosis. Current debate around Canada’s changing regulatory and legal framework highlights challenges in appropriately balancing the benefits and burdens created by requests for futile care.

  • end of life care
  • allocation of health care resources
  • attitudes toward death
  • distributive justice
  • living wills/advance directives
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Footnotes

  • Correction notice This article has been updated since it was first published online. The corresponding author's email address has been updated.

  • Contributors LV and TC contributed equally to the completion of this paper including conceptualisation, authorship, editing and submission. LV and TC are the sole contributors to this article. Decision-making regarding end-of-life care in Canada continues to be an extremely controversial and active topic of debate in the Canadian medical community. The widely publicised Ontario Superior Court of Justice’s 20 August 2019 ruling on Wawrzyniak v. Livingston has once again highlighted the urgent need for firm regulatory and legal reform. As hospital-based internists, both authors are frequently confronted with managing such cases at the bedside and hope to advance an agenda of reform. Both authors have scholarly interests in clinical ethics and health policy and hope that our passion for these subjects is reflected in our arguments for this submission. Sources of inspiration for this article have included popular media, previously published scholarly work, interactions with patients, as well as interactions with colleagues involved in the highlighted court rulings. LV will serve as the guarantor of this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement There are no data in this work

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