Medical futility at the end of life: the perspectives of intensive care and palliative care clinicians.

Details

Serval ID
serval:BIB_5E75486B15CE
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Medical futility at the end of life: the perspectives of intensive care and palliative care clinicians.
Journal
Journal of Medical Ethics
Author(s)
Jox R.J., Schaider A., Marckmann G., Borasio G.D.
ISSN
1473-4257 (Electronic)
ISSN-L
0306-6800
Publication state
Published
Issued date
2012
Volume
38
Number
9
Pages
540-545
Language
english
Notes
Publication types: Journal ArticlePublication Status: ppublish
Abstract
Objectives Medical futility at the end of life is a growing challenge to medicine. The goals of the authors were to elucidate how clinicians define futility, when they perceive life-sustaining treatment (LST) to be futile, how they communicate this situation and why LST is sometimes continued despite being recognised as futile. Methods The authors reviewed ethics case consultation protocols and conducted semi-structured interviews with 18 physicians and 11 nurses from adult intensive and palliative care units at a tertiary hospital in Germany. The transcripts were subjected to qualitative content analysis. Results Futility was identified in the majority of case consultations. Interviewees associated futility with the failure to achieve goals of care that offer a benefit to the patient's quality of life and are proportionate to the risks, harms and costs. Prototypic examples mentioned are situations of irreversible dependence on LST, advanced metastatic malignancies and extensive brain injury. Participants agreed that futility should be assessed by physicians after consultation with the care team. Intensivists favoured an indirect and stepwise disclosure of the prognosis. Palliative care clinicians focused on a candid and empathetic information strategy. The reasons for continuing futile LST are primarily emotional, such as guilt, grief, fear of legal consequences and concerns about the family's reaction. Other obstacles are organisational routines, insufficient legal and palliative knowledge and treatment requests by patients or families. Conclusion Managing futility could be improved by communication training, knowledge transfer, organisational improvements and emotional and ethical support systems. The authors propose an algorithm for end-of-life decision making focusing on goals of treatment.
Pubmed
Web of science
Create date
04/10/2012 17:04
Last modification date
20/08/2019 14:16
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