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Medical futility

D Robin Taylor, Calvin J Lightbody
The provision of healthcare is being challenged by a 'perfect storm' of forces including an increasing population with multiple comorbidities, high expectations and resource limitations, and in the background, the pre-eminence of the 'curative medical model'. Non-beneficial (futile) treatments are wasteful and costly. They have a negative impact on quality of life especially in the last year of life. Among professionals, frequent encounters with futility cause moral distress and demoralisation. The factors that drive non-beneficial treatments include personal biases, patient-related pressures and institutional imperatives...
February 24, 2018: Postgraduate Medical Journal
Thalia Arawi, Lama Charafeddine
Bioethics is a relatively new addition to bedside medical care in Arab world which is characterized by a special culture that often makes blind adaptation of western ethics codes and principles; a challenge that has to be faced. To date, the American University of Beirut Medical Center is the only hospital that offers bedside ethics consultations in the Arab Region aiming towards better patient-centered care. This article tackles the role of the bedside clinical ethics consultant as an active member of the medical team and the impact of such consultations on decision-making and patient-centered care...
February 20, 2018: Developing World Bioethics
Monique Aucoin, Kieran Cooley, Leena Anand, Melissa Furtado, Alex Canzonieri, Alexa Fine, Kathryn Fotinos, Ranjith Chandrasena, Larry J Klassen, Irvin Epstein, Wende Wood, Martin A Katzman
BACKGROUND: Many patients with depression fail to achieve remission after several consecutive treatments. Vitamin D deficiency is prevalent and new research suggests that it may have an impact on mood, primarily through an effect on neurotransmitters. Numerous observational studies suggest a relationship between low levels of vitamin D and increased incidence and severity of mood disorders. A small number of pilot studies have been undertaken but lack rigorous methodology required to draw conclusions about a clinical role for this nutrient in treatment resistant depression...
February 2018: Complementary Therapies in Medicine
Yi Lin Lee, Yee Yian Ong, Sze Ying Thong, Shin Yi Ng
Aim: Progress in medical care and technology has led to patients with more advanced illnesses being admitted to the Intensive Care Unit (ICU). The practice of approaching end-of-life (EOL) care decisions and limiting care is well documented in Western literature but unknown in Singapore. We performed a retrospective cohort study to describe the practice of EOL care in patients dying in a Singapore surgical ICU (SICU). The surgical critical care population was chosen as it is unique because surgeons are frequently involved in the EOL process...
January 2018: Indian Journal of Palliative Care
Eric Cornelis Theodorus Geijteman, Marcella van der Graaf, Frederika E Witkamp, Sanne van Norden, Bruno H Stricker, Carin C D van der Rijt, Agnes van der Heide, Lia van Zuylen
OBJECTIVES: Burdensome and futile interventions with the aim of prolonging life should be avoided in dying patients. However, current clinical practice has hardly been investigated.We examined the number and type of diagnostic and therapeutic medical interventions in hospitalised patients with cancer in their last days of life. In addition, we investigated if physician awareness of impending death affected the use of these interventions. METHODS: Questionnaire study and medical record study...
February 9, 2018: BMJ Supportive & Palliative Care
Emine Alp, Tuğba Tok, Leylagül Kaynar, Fatma Cevahir, İsmail Hakkı Akbudak, Kürşat Gündoğan, Mustafa Çetin, Jordi Rello
BACKGROUND: Haematological cancer (HC) patients are increasingly requiring intensive care (ICUs). The aim of this study was to investigate the outcome of HC patients in our ICU and evaluate 5 days-full support as a breakpoint for patients' re-assessment for support. METHODS: Retrospective study enrolling 112 consecutive HC adults, requiring ICU in January-December 2015. Patients' data were collected from medical records and Infection Control Committee surveillance reports...
February 8, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Christoph Weiser, Michael Poppe, Fritz Sterz, Harald Herkner, Christian Clodi, Christoph Schriefl, Alexandra Warenits, Mathias Vossen, Michael Schwameis, Alexander Nürnberger, Alexander Spiel
BACKGROUND: Outcome is generally poor in out of hospital cardiac arrests (OHCA) with initial non-shockable rhythms. Termination of resuscitation rules facilitate early prognostication at the scene to cease resuscitation attempts in futile situations and to proceed advanced life support in promising conditions. As pulseless electrical activity (PEA) is present as first rhythm in every 4th OHCA we were interested if the initial electrical frequency in PEA predicts survival. METHODS: All patients >18 years of age with non-traumatic OHCA and PEA as first rhythm between August 2013 and August 2015 from the Vienna Cardiac Arrest Registry were included in this retrospective observational study...
February 3, 2018: Resuscitation
Mohammad Mehrtak, Esmaeil Farzaneh, Shahram Habibzadeh, Aziz Kamran, Hamed Zandian, Abdollah Mahdavi
Background: Developing and guiding new knowledge are futile unless the organizational culture can also be transformed. Future leaders cannot emerge out of an organizational environment that is not conducive to the accumulation of experiences. Objective: The aim of this study was to explore the role of organizational culture in creating a succession-planning system at the Ministry of Health and Medical Education in 2014. Methods: The present qualitative framework analysis held interviews with 23 director generals, administrative directors and deputies from the headquarters of the Iranian Ministry of Health and Medical Education in 2014 who were selected through snowball sampling...
November 2017: Electronic Physician
Asha R Aggarwal, Iqbal Khan
Objectives: In the UK, cardiopulmonary resuscitation (CPR) should be undertaken in the event of cardiac arrest unless a patient has a "Do Not Attempt CPR" document. Doctors have a legal duty to discuss CPR with patients or inform them that CPR would be futile. In this study, final-year medical students were interviewed about their experiences of resuscitation on the wards and of observing conversations about resuscitation status to explore whether they would be equipped to have an informed discussion about resuscitation in the future...
2018: Advances in Medical Education and Practice
Rachel S Morris, Jessica Ruck, Alison M Conca-Cheng, Thomas J Smith, Thomas W Carver, Fabian M Johnston
BACKGROUND: Surgical patients increasingly have more comorbidities and are of an older age, complicating surgical decision-making in emergent situations. Little is known about surgeons' perceptions of shared decision-making in these settings. STUDY DESIGN: Twenty semi-structured interviews were conducted with practicing surgeons at two large academic medical centers. Thirteen questions and two case vignettes were used to assess perceptions of decision-making, considerations when deciding whether to offer surgery, and communication patterns with patients and families...
January 27, 2018: Journal of the American College of Surgeons
Yaseen M Arabi, Adel Alothman, Hanan H Balkhy, Abdulaziz Al-Dawood, Sameera AlJohani, Shmeylan Al Harbi, Suleiman Kojan, Majed Al Jeraisy, Ahmad M Deeb, Abdullah M Assiri, Fahad Al-Hameed, Asim AlSaedi, Yasser Mandourah, Ghaleb A Almekhlafi, Nisreen Murad Sherbeeni, Fatehi Elnour Elzein, Javed Memon, Yusri Taha, Abdullah Almotairi, Khalid A Maghrabi, Ismael Qushmaq, Ali Al Bshabshe, Ayman Kharaba, Sarah Shalhoub, Jesna Jose, Robert A Fowler, Frederick G Hayden, Mohamed A Hussein
BACKGROUND: It had been more than 5 years since the first case of Middle East Respiratory Syndrome coronavirus infection (MERS-CoV) was recorded, but no specific treatment has been investigated in randomized clinical trials. Results from in vitro and animal studies suggest that a combination of lopinavir/ritonavir and interferon-β1b (IFN-β1b) may be effective against MERS-CoV. The aim of this study is to investigate the efficacy of treatment with a combination of lopinavir/ritonavir and recombinant IFN-β1b provided with standard supportive care, compared to treatment with placebo provided with standard supportive care in patients with laboratory-confirmed MERS requiring hospital admission...
January 30, 2018: Trials
A A Eduard Verhagen
Requests for life-prolonging treatments can cause irresolvable conflicts between health-care providers and surrogates. The Multiorganization Policy Statement (Bosslet et al. 2015) with recommendations to prevent and manage these conflicts creates a good opportunity to examine how end-of-life decisions are made in Dutch neonatal intensive care units and how medical futility is defined. The Dutch equivalent of medical futility in the context of NICU care has grown and developed rather independently, within the typical legal, ethical, and cultural framework of Dutch society...
2018: Perspectives in Biology and Medicine
Robert M Veatch
In response to the criticism of Schneiderman and colleagues (2017) that two recent policy statements of professional medical organizations referred to some medical treatment that were traditionally called "futile" by the terms "inappropriate" or "potentially inappropriate," this critique accepts their claim challenging these terms as being hopelessly ambiguous. However, this critique rejects the conclusion they all share that clinicians or hospitals should have the unilateral authority to refuse to provide treatments that will plausibly achieve the end that the patient or surrogate is pursuing...
2018: Perspectives in Biology and Medicine
Robert D Truog
Debate about the concept of medical futility is often polarized around two views. One is that futility is simply an acknowledgment of the limitations of modern medicine, a corollary of the fact of human mortality. The other is that futility is a judgment that is always grounded in a particular set of values, and that medical professionals have no right to impose their value judgments on patients and families who do not share their perspective. This essay argues that these dichotomous views can be reconciled by appreciating the importance of the context in which the dialogue occurs...
2018: Perspectives in Biology and Medicine
Thaddeus Mason Pope
The primary objective of this article is to defend the vocabulary in the Multiorganization Policy Statement. The Multiorganization Statement narrows but does not abolish the term futility. Rather, it offers a richer and more precise vocabulary that facilitates better ethical decision-making. The secondary objective of this article is to defend the continuing utility of the terms and concepts "quantitative futility" and "qualitative futility" defended by Schneiderman, Jecker, and Jonsen (2017).
2018: Perspectives in Biology and Medicine
Michael Nair-Collins
Conflicts between providers and patients or their families surrounding end-of-life care are both regrettable and extremely challenging, interpersonally and ethically, for all involved. These conflicts often implicate the concept of medical futility. The concept of futility is too often conflated with distinct concepts that are more ethically salient, including the fiduciary responsibility to assess surrogate decision-making, and distributive justice. By distinguishing these concepts from futility, it becomes clear that there are some situations in which forgoing life-sustaining treatment over objection is permissible, and perhaps even obligatory...
2018: Perspectives in Biology and Medicine
Laura Miller-Smith
Futility has wrongly been applied over the past decades to clinical scenarios where treatment disputes exist, but where true physiological futility is not certain. This particularly applies to the pediatric critical care arena, where a major source of ethical debate and moral concern surrounds decisions about appropriateness of treatment, and not necessarily futility. In the pediatric intensive care unit, Schneiderman and colleagues' (2017) definitions of quantitative and qualitative futility are rarely applicable...
2018: Perspectives in Biology and Medicine
Franklin G Miller
Judgments of futility are always relative to some goal. In light of that proposition, continued treatment for those diagnosed as "brain dead" is not necessarily futile.
2018: Perspectives in Biology and Medicine
Samantha F Knowlton, Joseph J Fins
Futility disputes are more likely to be resolved-and relational breaches repaired-by engaging in a process that fosters communication between clinicians, patients, and families. This essay calls for mediative fluency. The preemptive use of a futility definition can stifle conversation when it is needed most, exacerbating the very power imbalances and associated health disparities that often precipitate futility disputes. When clinicians, patients, and families engage in dialogue, clinicians can appreciate what motivates requests for what is thought to be futile care, and patients and families can better understand the limits of available therapies...
2018: Perspectives in Biology and Medicine
Véronique Fournier
This article offers a comparative perspective of the controversy about the use of the term futility as presented by Schneiderman and colleagues (2017). The English concept of "medical futility" has no semantic equivalent in the French language. The traditional term used to translate it was "therapeutic obstinacy," which changed to "unreasonable obstinacy" when the first end-of-life law was adopted in 2005. The change was done in order to demedicalize the concept and make it less objective and less scientific...
2018: Perspectives in Biology and Medicine
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