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Back to Module 9: Medical Futility Important Questions about Medical Futility

Important Questions about Medical Futility

• Physicians and Futility
• Patient-Centered Care
• Conflict over Treatment

Important Questions about Medical Futility

Physicians and Futility

• Patients/families invested in interventions

• Physicians/other professionals invested in interventions (less commonly acknowledged)

• Inclination to intervene

• Maintain hope
• Belief that the physician's job is to maintain life at all costs
• Avoid shame or sense of failure
• Need to feel that "everything possible" was done
• Assurance of no guilt after death of patient

• Any party may perceive futility

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Patient-Centered Care

• "Who are we doing this for?" fundamental question

• Patient's goals and values critical

• Resolution of differences in goals showing respect

• Health professionals' expertise and knowledge
• Centrality of the patient

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Conflict over Treatment

• Unresolved conflicts lead to misery

• Most conflicts can be resolved through...

• Communication
• Compassion
• Empathy

• Try to understand and resolve differences--physician's obligation and role

• Support patient and family, and relieve suffering
• Understand and resolve differences in perception about treatment

• Base decisions on informed consent, advance care planning, and goals of care (see Module 1: Advance Care Planning, and Module 7: Goals of Care)

• Most disagreements about futile care are result of:

• Misunderstandings


• Lack of physician attention to the family's or physician's emotional reaction to the patient's dying

• Critical issue: understand why there is disagreement

• Conflicts can often be resolved in a way that is respectful of the patient/family and physician

• Focus on understanding points of view will help with bereavement

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