00:01
Another instance where
the clinician may judge
that the burdens
outweigh the benefits
is what historically has
been termed futile treatment.
00:11
Really, we've moved
away from the idea of
calling something futile.
00:17
Futility, has been
defined in various ways
as something that's non beneficial
or medically ineffective.
00:25
That is difficult
to piece together
of what's the benefit,
what's the burden?
It's really in the
eye of the beholder,
and sometimes that's the
patient to make those decisions.
00:36
So what we've decided,
in the clinical ethics realm
is it really should only
apply to those things
that will not meet
physiologic goals.
00:47
So a futile treatment
is an intervention
that will not accomplish the
intended physiologic effect
that you're hoping to achieve.
00:56
So take, for example,
a patient had a left
ventricular aneurysm
that has now burst open,
performing CPR, doing
chest compressions,
when their heart has no
ability to pump anymore.
01:09
That would be a
futile treatment.
01:11
So it does not need to be
offered to the patient.
01:15
So futile treatments are things
that the clinician can decide
not to even offer
potentially
inappropriate treatments
might be things where
they give their rationale,
their recommendation for why it
may not be appropriate to offer it.
01:29
But still, it's an
informed consent process
trying to work with
the patient and family
to reach a resolution
about what should be done.
01:36
So take another example of
where treatment might be
judged to be medically futile.
01:41
Here the healthcare
professional has no obligation
to provide the treatment.
01:46
Take, for example, a patient
that's actively dying
from overwhelming sepsis,
it is clear that
CPR will not work.
01:53
And to offer it would
be inappropriate on the,
in the viewpoint
of the clinician.
02:00
So, it's not just that they,
decide not to offer it, but
they need to disclose that
to the patient or to their
authorized decision maker,
that a DNA are order is
going to be put in place
not unilaterally, but with
informing the decision maker,
that this is going to be
what we're going to
do going forward.
02:22
Now, when this is done in a
caring and sensitive manner,
and your frank understanding
what the clinical situation is,
may be the case that actually
the patient and the family
sort of agree with this "Do Not
Attempt Resuscitation order".
02:36
They can understand
the rationale
for why the physician is
considering it futile,
and not going to offer
it in the first place.
02:42
These are all very
challenging situations.
02:46
But it's an
opportunity to again,
have a discussion
to a goals of care,
family meeting,
to really try to understand
the clinical situation.
02:55
And why the clinician feels
that the burdens
outweigh the benefits,
or the physiologic
goals cannot be met.