Futile Treatment

by Mark Hughes, MD, MA

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    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.

    About the Lecture

    The lecture Futile Treatment by Mark Hughes, MD, MA is from the course Ethical Considerations in Palliative Care.

    Included Quiz Questions

    1. Intervention that cannot accomplish physiological goals
    2. Useless treatment
    3. Placebo treatment
    4. Intervention that cannot accomplish medicolegal goals
    5. Expensive treatment
    1. A healthcare professional has no obligation to provide futile treatment.
    2. A healthcare professional has a non-binding obligation to provide futile treatment.
    3. A healthcare professional should never discuss futile treatments.
    4. A healthcare professional should only discuss futile treatments in the intensive care unit.
    5. The emergency room is the only area where futile treatment may be administered.

    Author of lecture Futile Treatment

     Mark Hughes, MD, MA

    Mark Hughes, MD, MA

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