Medical Futility
Popular culture, as gleaned from TV shows and the Internet, too often perceives medicine as a "magic bullet." Whatever is broken, damaged, or in need of repair can be restored to good working order in 60 minutes or less. Medical culture, on the other hand, often finds itself trying new and sometimes dubious treatment modalities in an attempt to try to restore the patient to a state of improved health.
But sometimes, there will be no "improvement" -- the patient is dying. Patients, their families or surrogates, and providers are often reluctant to move from curative to palliative care because doing so appears to be "giving up" or "ceasing to care."
The Ethics Committee Consortium is addressing these issues by developing Medical Futility Guidelines both to help determine when the redirection of medical treatment is indicated and to provide aid in communicating that further treatment is "futile."
These guidelines are being prepared for members of ethics committees to take to their respective institutions for review and possibly updating of medical futility policies. The document will also be distributed among physicians, nurses and other hospital personnel, patients, families and surrogates.
The Center for Practical Bioethics is well-suited to this enterprise since its Ethics Committee Consortium has previously prepared over a dozen similar documents. Most recently, the Guidelines for Withholding/Withdrawing Life-Sustaining Treatment referred to the medical futility issue and members judged that it was time to face futility head on. With its history of support for patient rights, the Center now turns its attention to an issue where limits may be placed on autonomy.
Although the cast of characters may change, the issues in futility cases remain the same. The challenge is to know when the point is reached and how to communicate best with all those involved: patients, families and surrogates along with providers.
Medical futility can be judged by providers in terms of the effects of treatment on patients; likewise it can be judged by patients, families and surrogates in terms of the values of the patient. In both instances, it is essential to provide support to those involved and to keep lines of communication open.
There is no easy calculus to determine when the "futility point" is reached. Nor do we always recognize it at the same time.
We do know this -- caring is never futile treatment.
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When is medical treatment futile? Who decides? There is no easy way to determine when medical treatment is futile. The same can be said for who decides when medical treatment for a loved one should be discontinued. That is why the Center for Practical Bioethics, along with the Kansas City Regional Hospital Ethics Committee Consortium, has developed a set of guidelines to help patients, families and medical professionals make that choice.
