ethique acharnement thérapeutique

BALANCING QUALITY OF LIFE AND MEDICAL FUTILITY: AN ETHICAL DILEMMA IN END STAGE RENAL DISEASE

Sat, 17 May 2025 08:18:23 +0000

Author Names: Guan J.H.C.,Neo H.Y.

Database Source: Embase Weekly Updates

Journal Title: BMJ Supportive and Palliative Care

Article Title: BALANCING QUALITY OF LIFE AND MEDICAL FUTILITY: AN ETHICAL DILEMMA IN END STAGE RENAL DISEASE

Year: 2024

Issue: Supplement 3

Volume: 14

Abstract: Decisions around dialysis withdrawal can be highly complex and challenging for patients, caregivers, and healthcare providers. There are various reasons why dialysis withdrawal may be considered, including access failure, acute medical complications, or chronic deterioration. Shared decision-making is recommended to align this decision with the patient and family's goals, values, and preferences.1 However, problems can arise when there is a misalignment or disagreement between what the family/patient desires and what the medical team deems medically appropriate. In this case, we discuss a 74-year-old woman with endstage renal failure on intermittent haemodialysis. She lacks decision-making capacity and is bedbound and dependent in her activities of daily living due to her advanced dementia. Her recent medical deterioration and lack of access has made it difficult to continue haemodialysis. Despite the medical team's recommendation to withdraw dialysis, her main spokesperson, a close friend, does not agree and insists on pursuing further treatment. This presents an ethical dilemma - is it appropriate to persist with dialysis in this medically frail patient, at the spokesperson's insistence, when the treatment may not be medically appropriate or beneficial given her current state? The Jonsen's 4 box ethical framework was used to consider the medical indications, patient preferences, quality of life, and contextual features to plan care in the patient's best interests in the absence of decision-making capacity.

Ethical considerations on the role of artificial intelligence in defining the futility in emergency surgery

Thu, 27 Mar 2025 00:00:00 +0000

Int J Surg. 2025 May 1;111(5):3178-3184. doi: 10.1097/JS9.0000000000002347.

NO ABSTRACT

PMID:40143750 | PMC:PMC12165478 | DOI:10.1097/JS9.0000000000002347

Introduction: Trauma and Surrogate Decision Makers: An Argument for Moral Priority in Futility Disputes

Mon, 10 Feb 2025 00:00:00 +0000

J Clin Ethics. 2025 Spring;36(1):39. doi: 10.1086/733270.

NO ABSTRACT

PMID:39928979 | DOI:10.1086/733270

Commentary on Fiester's "TIEC, Trauma Capacity, and the Moral Priority of Surrogate Decision Makers in Futility Disputes," Others' Responses on This Topic, and, Then, Her Responses to Them

Mon, 10 Feb 2025 00:00:00 +0000

J Clin Ethics. 2025 Spring;36(1):88-91. doi: 10.1086/733186.

ABSTRACT

AbstractIn this issue Autumn Fiester and several other experts explore optimal ethical approaches to surrogate decision-making and trauma-informed ethics consultation (TIEC). Trauma-informed care is currently recommended in many clinical contexts in which the risks of patients being traumatized by their illness and its treatment are present. This care gives priority to patients feeling safe, an asymptotic goal that prescribes no one standard practice for all patients, but one that prescribes individualized treatment tailored to each patient's idiosyncratic needs. Core points Fiester makes are how patients are especially prone to feeling traumatized when others, as is always the case with their providers, have greater power over them and the rarely considered conclusion that although providers have exceptional medical expertise and experience, this does not necessarily provide them with greater ethical expertise than their patients or others. Fiester's most radical contention may be that providers, including ethics consultants, give priority to patients' and surrogate decision makers' feelings. I discuss here these contentions and Fiester's main aim of first creating and then maintaining trust and caring feelings between all parties, no matter how much initially they may disagree. I discuss, too, how legally her suggestions may be implemented immediately.

PMID:39928972 | DOI:10.1086/733186

TIEC, Trauma Capacity, and the Moral Priority of Surrogate Decision Makers in Futility Disputes

Mon, 10 Feb 2025 00:00:00 +0000

J Clin Ethics. 2025 Spring;36(1):40-51. doi: 10.1086/733392.

ABSTRACT

AbstractIn the past 15 years, trauma-informed care (TIC) has evolved as a new paradigm in healthcare that recognizes the impact of past traumas on patients' and families' healthcare experience while seeking to avoid inducing new trauma during clinical care. A recent paper by Lanphier and Anani extends TIC principles to healthcare ethics consultation (HEC) in what they label "trauma-informed ethics consultation" (TIEC), which calls for the "addition of trauma informed awareness, training, and skill in clinical ethics consultation." While Lanphier and Anani claim that TIEC is "novel, but not radical" because it builds on the approach to HEC endorsed by the American Society for Bioethics and Humanities, I believe that TIEC has radical implications, particularly regarding ethical obligations to surrogate decision makers (SDMs). Given what I call the SDM's "trauma capacity," I argue that TIEC accords moral priority to SDMs over patients in certain types of end-of-life cases, particularly futility disputes, which is a radical departure from the conventional HEC approach to SDMs.

PMID:39928969 | DOI:10.1086/733392

"It always needs a higher level of care than what I can provide": Practical, ethical, and administrative tensions arising from the integration of wound care services into syringe service programs in Maryland.

Wed, 01 Jan 2025 05:00:00 +0000

International Journal of Drug Policy; 01/01/2025
(AN 182120909); ISSN: 09553959
CINAHL Complete

"It always needs a higher level of care than what I can provide": Practical, ethical, and administrative tensions arising from the integration of wound care services into syringe service programs in Maryland

Sat, 14 Dec 2024 00:00:00 +0000

Int J Drug Policy. 2025 Jan;135:104685. doi: 10.1016/j.drugpo.2024.104685. Epub 2024 Dec 13.

ABSTRACT

INTRODUCTION: The emergence of xylazine into the U.S. drug supply has increased demand for wound care services among people who inject drugs (PWID). Traditional health care settings have historically been ill-equipped to accommodate the complex needs of PWID and syringe service programs (SSPs) have created wound care services to fill the gap. In doing so, many SSPs are extending the scope of their services beyond health promotion into a quasi-medical space that is largely unregulated.

METHODS: We conducted 10 qualitative interviews with staff employed by eight SSP programs across six counties in the state of Maryland to explore how they have navigated shifting demand for more intensive wound care services.

RESULTS: Contested boundaries in training of non-medical staff, lack of clarity in SSP-based providers' scope of practice, and conflicts in operational norms and standards between harm reduction and medical services are significant sources of tension that impact delivery of wound care services in SSP settings. In taking on responsibility to provide wound care services to PWID, SSPs take on significant administrative, practical, and ethical burden that increase vulnerability to medicolegal liability.

DISCUSSION: There is a significant unmet need for increased resources, administrative support, and mentorship to guide the integration of medicalized wound care into SSP programs. Additionally, efforts to expand access to community-based wound care services for PWID should not replace efforts to promote timely access to services in more traditional healthcare settings.

PMID:39674056 | PMC:PMC11737354 | DOI:10.1016/j.drugpo.2024.104685

Medical futility at the end of life: the first qualitative study of ethical decision-making methods among Turkish doctors.

Fri, 01 Nov 2024 04:00:00 +0000

BMC Medical Ethics; 11/01/2024
(AN 180626616); ISSN: 14726939
CINAHL Complete

Medical futility at the end of life: the first qualitative study of ethical decision-making methods among Turkish doctors

Fri, 01 Nov 2024 00:00:00 +0000

BMC Med Ethics. 2024 Nov 1;25(1):122. doi: 10.1186/s12910-024-01120-1.

ABSTRACT

BACKGROUND: The swift advancement of intensive care medicine, coupled with technological possibilities, has prompted numerous ethical inquiries regarding decision-making processes concerning the withholding or withdrawal of treatment due to medical futility. This study seeks to delineate the decision-making approaches employed by intensive care physicians in Türkiye when faced with medical futility at the end of life, along with an ethical evaluation of these practices.

METHODS: Grounded theory, a qualitative analysis method was employed, conducting semi-structured, in-depth interviews with eleven intensive care physicians in Türkiye. The subsequent text analysis was carried out using MAXQDA software.

RESULTS: Participants assert that the decisions made by Turkish physicians determine whether treatment is futile, rely on medical consensus, and lack a standardized decision-making process. The decisions are influenced by legal and social pressures, resource constraints, and occasional conflicts of interest. The significance of professional hierarchy is notable, with limited consideration given to the opinions of nurses and other staff. The unstructured medical consensus processes are shaped by normative concepts such as benefit, age, justice, and conscience. Furthermore, it was observed that the conscientious opinions of physicians carry more weight than adherence to ethical principles and guidelines.

CONCLUSION: To create optimal conditions for doctors to make ethically justifiable decisions, the dynamics within the treatment team should be improved, emphasizing the minimization of hierarchy, and ensuring the active participation of all team members in the decision-making process. Additionally, efforts should be directed toward narrowing the gap between the conscience of the individual doctor and established ethical principles. A potential solution lies in the nationwide implementation of clinical ethics committees and the establishing of clinical ethics guidelines, aiming to address, and overcome the identified challenges.

PMID:39482685 | PMC:PMC11529328 | DOI:10.1186/s12910-024-01120-1

Futility and life expectancy: an increasing ethical and clinical challenge in emergency surgery

Mon, 04 Mar 2024 00:00:00 +0000

Minerva Surg. 2024 Jun;79(3):354-355. doi: 10.23736/S2724-5691.24.10274-2. Epub 2024 Mar 4.

NO ABSTRACT

PMID:38436602 | DOI:10.23736/S2724-5691.24.10274-2

Ethical issues surrounding a patient requesting inappropriate care.

Thu, 01 Feb 2024 05:00:00 +0000

Journal of the American Academy of Dermatology; 02/01/2024
(AN 174709612); ISSN: 01909622
CINAHL Complete

Moral Intuitions About Futility as Prompts for Evaluating Goals in Mental Health Care

Mon, 11 Sep 2023 00:00:00 +0000

AMA J Ethics. 2023 Sep 1;25(9):E690-702. doi: 10.1001/amajethics.2023.690.

ABSTRACT

Mental health professionals' moral intuitions about futility should prompt reevaluation of goals of care and care plans. Mostly, it will suffice to improve the care plan and/or slightly adjust the goal of care (eg, lower expectations), which is standard practice. Sometimes, however, all care plans that seek to reduce core symptoms (ie, that pursue a curative goal) are most likely futile and thus should not be imposed. Here, it may be in the patient's best interest to change the goal of care toward palliation (ie, harm reduction, relief of suffering, and best possible quality of life). Thus, futility can function as a moral counterweight to the duty to treat, helping mental health professionals find the right balance between over- and undertreatment.

PMID:37695872 | DOI:10.1001/amajethics.2023.690

Futility considerations in surgical ethics

Mon, 06 Feb 2023 00:00:00 +0000

Ann Med Surg (Lond). 2023 Jan 23;85(1):1-5. doi: 10.1097/MS9.0000000000000114. eCollection 2023 Jan.

ABSTRACT

The topic of futility has been intensely debated in bioethical discourse. Surgical futility encompasses considerations across a continuum of care, from decision-making during initial triage, to the choice to operate or refrain from operating on the critically ill, to withdrawal of life-supporting care. Determinations over futility may result in discord between providers and patients or their families, who might insist that treatment be provided at all costs to sustain life. In this manuscript, we will explore some of the possible sources for and manifestations of these disputes, and describe approaches by which to resolve them. Part I will briefly address some of the reasons that families ask for life-sustaining measures against medical advice in the surgical setting. These include variable determinations of both the quality of life and the inherent value of life (stemming from religious, cultural, and personal beliefs). Part II will detail some general instances in which physicians and surgeons can override requests to provide futile treatment, namely: instances of resource scarcity, interventions which carry a high probability of harm, and those that carry significant moral distress. To conclude, Part III will provide concrete guidelines for navigating futility, making an argument for individual case-based communication models in surgical decision-making.

PMID:36742120 | PMC:PMC9893435 | DOI:10.1097/MS9.0000000000000114

The concept of natural death today, between futility and ethical necessity. A concept for the 21st century

Fri, 09 Dec 2022 00:00:00 +0000

Cuad Bioet. 2022 Sep-Dec;33(109):293-302. doi: 10.30444/CB.134.

ABSTRACT

The concept of natural death has been present in philosophical, medical and social reflection for centuries, fulfilling a double function: understanding human finitude and hoping for a desirable way to reach the end of our days. Today, those goals have been blurred by the sense of control over death that comes from the high technology of medicine, the dreams of immortality nurtured by the media, and the confusing line drawn between autonomy and dignity. This article studies the concept of natural death that in the past 20th century was the subject of debate between health workers and bioethicists and that at the beginning of this 21st century has already begun to be questioned. The ″naturalness″ of death was intended to be a kind of ethical frontier in the face of any form of violence, injustice, excessive technicalization or interference with the human will. Today, many of these aspects are blurred in a context as unnatural as he hospital one. In addition, the forensic field has also encountered serious difficulties in excluding any human, voluntary or involuntary intervention, in a large part of the deaths, since there is little natural in what we breathe, eat or drink. Based on all this, a redefinition proposal is offered that responds to a double need: the social need to integrate the inevitable mortality and the shared personal need to reach the end after a humanizing process that excludes all human responsibility. It is anthropologically possible and ethically desirable natural death.

PMID:36493415 | DOI:10.30444/CB.134

Existential suffering, futility, and the mental stress of moral distress in health care.

Sat, 01 Oct 2022 04:00:00 +0000

Heart & Mind; 10/01/2022
(AN 160902657); ISSN: 24686476
CINAHL Complete

Ethical issues surrounding a patient requesting inappropriate care

Sat, 13 Aug 2022 00:00:00 +0000

J Am Acad Dermatol. 2024 Feb;90(2):450-451. doi: 10.1016/j.jaad.2022.08.011. Epub 2022 Aug 10.

NO ABSTRACT

PMID:35963287 | DOI:10.1016/j.jaad.2022.08.011

Futility and palliative psychiatry in mental health: New clinical and ethical challenges

Sat, 18 Jun 2022 00:00:00 +0000

Rev Colomb Psiquiatr (Engl Ed). 2022 Apr-Jun;51(2):87-88. doi: 10.1016/j.rcpeng.2022.06.001. Epub 2022 Jun 15.

NO ABSTRACT

PMID:35717388 | DOI:10.1016/j.rcpeng.2022.06.001

Futility: a perennial issue for medical ethics

Thu, 23 Sep 2021 00:00:00 +0000

J Med Ethics. 2021 Oct;47(10):649. doi: 10.1136/medethics-2021-107866.

NO ABSTRACT

PMID:34551933 | DOI:10.1136/medethics-2021-107866

Futility and Palliative Psychiatry in Mental Health: New Clinical and Ethical Challenges

Thu, 18 Mar 2021 00:00:00 +0000

Rev Colomb Psiquiatr (Engl Ed). 2020 Dec 14:S0034-7450(20)30097-4. doi: 10.1016/j.rcp.2020.10.002. Online ahead of print.

NO ABSTRACT

PMID:33734995 | DOI:10.1016/j.rcp.2020.10.002

THE ETHICS OF IN‐HOSPITAL DO‐NOT‐RESUSCITATE ORDERS AND LIMITATIONS OF MEDICAL CARE: LEAVING BEHIND PATERNALISM AND 'FUTILITY'...Royal Australasian College of Physicians (RACP) Congress, April 28-May 1, 2021, Brisbane, Queensland.

Sat, 02 May 2020 04:00:00 +0000

Internal Medicine Journal; 05/02/2020
(AN 143431820); ISSN: 14440903
CINAHL Complete

Ethical Considerations in End-of-life Care in the Face of Clinical Futility

Thu, 06 Dec 2018 00:00:00 +0000

Continuum (Minneap Minn). 2018 Dec;24(6):1789-1793. doi: 10.1212/CON.0000000000000680.

ABSTRACT

Management of patients with terminal brain disorders can be medically, socially, and ethically complex. Although a growing number of feasible treatment options may exist, there are times when further treatment can no longer meaningfully improve either quality or length of life. Clinicians and patients should discuss goals of care while patients are capable of making their own decisions. However, because such discussions can be challenging, they are often postponed. These discussions are then conducted with patients' health care proxies after patients lose the capacity to make their own decisions. Disagreements may arise when a patient's surrogate desires continued aggressive interventions that are either biologically futile (incapable of producing the intended physiologic result) or potentially inappropriate (potentially capable of producing the patient's intended effect but in conflict with the medical team's ethical principles). This article explores best practices in addressing these types of conflicts in the critical care unit, but these concepts also broadly apply to other sites of care.

PMID:30516606 | DOI:10.1212/CON.0000000000000680

Debating Medical Utility, Not Futility: Ethical Dilemmas in Treating Critically Ill People Who Use Injection Drugs

Tue, 28 Aug 2018 00:00:00 +0000

J Law Med Ethics. 2018 Jun;46(2):241-251. doi: 10.1177/1073110518782925.

ABSTRACT

Physicians who care for critically ill people with opioid use disorder frequently face medical, legal, and ethical questions related to the provision of life-saving medical care. We examine a complex medical case that illustrates these challenges in a person with relapsing injection drug use. We focus on a specific question: Is futility an appropriate and useful standard by which to determine provision of life-saving care to such individuals? If so, how should such determinations be made? If not, what alternative decisionmaking framework exists? We determine that although futility has been historically utilized as a justification for withholding care in certain settings, it is not a useful standard to apply in cases involving people who use injection drugs for non-medical purposes. Instead, we are welladvised to explore each patient's situation in a holistic approach that includes the patient, family members, and care providers in the decision-making process. The scope of the problem illustrated demonstrates the urgent need to definitively improve outcomes in people who use injection drugs. Increasing access to high quality medication-assisted treatment and psychiatric care for individuals with opioid use disorder will help our patients achieve a sustained remission and allow us to reach this goal.

PMID:30146983 | PMC:PMC6530472 | DOI:10.1177/1073110518782925

Debating Medical Utility, Not Futility: Ethical Dilemmas in Treating Critically Ill People Who Use Injection Drugs.

Fri, 01 Jun 2018 04:00:00 +0000

Journal of Law, Medicine & Ethics; 06/01/2018
The article discusses ethical dilemmas faced by physicians and other medical care personnel when treating critically ill opioid abusers who use injection drugs, focusing on the debate between medical utility and the concept of futile medical care. It examines the medical effects of opioid abuse, the use of data in clinical decision making, and cost effectiveness of treatment.
(AN 130847566); ISSN: 10731105
Health Business Elite

Point: Moral distress can indicate inappropriate care at end-of-Life.

Fri, 01 Jun 2018 04:00:00 +0000

Psycho-Oncology; 06/01/2018
The article discusess the impact of moral distress on burnout and job dissatisfaction among physicians. Topics discussed include role of physicians in providing end of life care; impact of distress play in determining the futility of a plan of care; and medical and psychosocial complexity faced by clinicians in oncology.
(AN 129957319); ISSN: 10579249
CINAHL Complete

Point: Moral distress can indicate inappropriate care at end-of-Life

Sat, 24 Mar 2018 00:00:00 +0000

Psychooncology. 2018 Jun;27(6):1490-1492. doi: 10.1002/pon.4713. Epub 2018 May 1.

NO ABSTRACT

PMID:29569796 | DOI:10.1002/pon.4713

Medical Futility and Potentially Inappropriate Treatment: Better Ethics with More Precise Definitions and Language

Tue, 30 Jan 2018 00:00:00 +0000

Perspect Biol Med. 2018;60(3):423-427. doi: 10.1353/pbm.2018.0018.

ABSTRACT

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).

PMID:29375074 | DOI:10.1353/pbm.2018.0018

Getting Past Words: Futility and the Professional Ethics of Life-Sustaining Treatment

Tue, 30 Jan 2018 00:00:00 +0000

Perspect Biol Med. 2018;60(3):319-327. doi: 10.1353/pbm.2018.0003.

ABSTRACT

For nearly three decades, clinicians and bioethicists have debated about use of the term futile to describe end-of-life medical interventions that clinicians believe are no longer warranted. In clinical practice, the term is most often invoked when a family of a dying or permanently unconscious patient insists upon such interventions, despite the medical team's belief or recommendation that they be withheld or withdrawn. This essay argues that each of the commonly used terms for these interventions (futile, inappropriate, and nonbeneficial) captures an important, different, and complementary facet of these conflicts in end-of-life medical care. Rather than continuing to debate which term is best, clinicians and bioethicists should direct their attention to the professional ethics of end-of-life care and the clinical and organizational factors that create or contribute to these so-called "futility cases."

PMID:29375059 | DOI:10.1353/pbm.2018.0003

Doing What We Shouldn't: Medical Futility and Moral Distress.

Wed, 01 Feb 2017 05:00:00 +0000

American Journal of Bioethics; 02/01/2017
The author offers insights on the use and necessity of cardiopulmonary resuscitation (CPR), in response to the article "Irrational Exuberance: Cardiopulmonary Resuscitation as Fetish" by P. M. Rosoff and L. J. Schneiderman, published within the issue. Topics explored include the perception of healthcare providers, patients, and the media on CPR, the need to consider patient outcomes associated with the procedure, and the need to respect wishes and values of the patient before performing CPR.
(AN 120896377); ISSN: 15265161
CINAHL Complete

Doing What We Shouldn't: Medical Futility and Moral Distress

Tue, 24 Jan 2017 00:00:00 +0000

Am J Bioeth. 2017 Feb;17(2):41-43. doi: 10.1080/15265161.2016.1265170.

NO ABSTRACT

PMID:28112617 | DOI:10.1080/15265161.2016.1265170

The Ethics of Futility across the Age Continuum.

Sun, 01 Jan 2017 05:00:00 +0000

Ethics of Futility across the Age Continuum; 01/01/2017
Much has been written on the topic of medical futility with reports of its existence dating back to the time of Hippocrates. However, the majority of the research on the topic has been on the adult population. Very little literature addresses the presence of medically futile treatment across the age continuum identifying issues that impact neonates, pediatrics, as well as adults. This dissertation addresses the gap in the literature by considering the ethical problem of medical futility across the age continuum. By addressing the common thread of futility, there is an imperative for a call to action that encompasses the span of organizational ethics. This span not only includes the clinical and professional ethics, but also the business ethics. A broad review of the literature on both medical futility and moral distress was accomplished. This yielded an integrative approach to the ethics of medical futility at the end-of-life across the age continuum as well as its effect on the moral distress of the nurses caring for these patients. Findings indicate that medical futility, or inappropriate medical treatments at the end-of-life, are to be found in all critical care units across the age continuum. Although there are commonalities, each age group contends with ethical dilemmas surrounding the ethics of inappropriate medical treatments that are specific to their age group. The inappropriate medical treatments are not only the number one cause of moral distress in nurses, but also create moral distress for physicians and other allied health professionals. Increasing the conversation across the age continuum, that begins in nursing and medical schools, is needed to increase the awareness of medical futility and develop strategies to confront it. Improving communication, plus the use of advance directives and palliative care for all age groups, holds the greatest hope for the future in minimizing futile treatments at the end-of-life.
(AN 124664880)
CINAHL Complete

Ethics in practice: is it futile to talk about 'futility'?

Sun, 05 Jun 2016 00:00:00 +0000

Eur J Anaesthesiol. 2016 Jul;33(7):473-4. doi: 10.1097/EJA.0000000000000428.

NO ABSTRACT

PMID:27261951 | DOI:10.1097/EJA.0000000000000428

Are ethical responses clear to providers if family requests inappropriate care?

Mon, 01 Feb 2016 05:00:00 +0000

Medical Ethics Advisor; 02/01/2016
The article focuses on the issue of paternalistic care imposed on patients instead of providing liberty for alternative care, and talks of challenges of deciding on appropriateness of treatment, policy on futile medical intervention, and discussing medical imitations with family members.
(AN 112635795); ISSN: 08860653
CINAHL Complete

Professionally Responsible Clinical Ethical Judgments of Futility.

Sat, 01 Aug 2015 04:00:00 +0000

American Journal of Bioethics; 08/01/2015
(AN 109822988); ISSN: 15265161
CINAHL Complete

Professionally Responsible Clinical Ethical Judgments of Futility

Fri, 31 Jul 2015 00:00:00 +0000

Am J Bioeth. 2015;15(8):54-6. doi: 10.1080/15265161.2015.1045096.

NO ABSTRACT

PMID:26225523 | DOI:10.1080/15265161.2015.1045096

Ethical Opportunities with the Perioperative Surgical Home: Disruptive Innovation, Patient-Centered Care, Shared Decision Making, Health Literacy, and Futility of Care

Thu, 23 Apr 2015 00:00:00 +0000

Anesth Analg. 2015 May;120(5):1158-1162. doi: 10.1213/ANE.0000000000000700.

NO ABSTRACT

PMID:25899278 | DOI:10.1213/ANE.0000000000000700

The determination of quality of life and medical futility in disorders of consciousness: reinterpreting the moral code of Islam

Wed, 07 Jan 2015 00:00:00 +0000

Am J Bioeth. 2015;15(1):14-6. doi: 10.1080/15265161.2015.975578.

NO ABSTRACT

PMID:25562215 | PMC:PMC4311952 | DOI:10.1080/15265161.2015.975578

The Determination of Quality of Life and Medical Futility in Disorders of Consciousness: Reinterpreting the Moral Code of Islam.

Thu, 01 Jan 2015 05:00:00 +0000

American Journal of Bioethics; 01/01/2015
(AN 103871055); ISSN: 15265161
CINAHL Complete

Futility and the care of surgical patients: ethical dilemmas

Fri, 23 May 2014 00:00:00 +0000

World J Surg. 2014 Jul;38(7):1631-7. doi: 10.1007/s00268-014-2592-1.

ABSTRACT

Futility has been a contentious topic in medicine for several decades. Surgery in critical or end-of-life situations often raises difficult questions about futility. In this article, we discuss the definition of futility, methods for resolving futility disputes, and some ways to reframe the futility debate to a more fruitful discussion about the goals of care, better communication between surgeon and patient/surrogate, and palliative surgical care. Many definitions of futile therapy have been discussed. The most controversial of these is "qualitative futility" which describes a situation in which the treatment provided is likely to result in an unacceptable quality of life. This is an area of continued controversy because it has been impossible to identify universally held beliefs about acceptable quality of life. Many authors have described methods for resolving futility disputes, including community standards and legalistic multi-step due process protocols. Others, however, have abandoned the concept of futility altogether as an unhelpful term. Reframing the issue of futility as one of inadequate physician-patient communication, these authors have advocated for methods of improving communication and strengthening the patient-physician relationship. Finally, we discuss the utilization of consultants who may be of use in resolving futility disputes: ethics committees, palliative care specialists, pastoral care teams, and dedicated patient advocates. Involving these specialists in a futility conflict can help improve communication and provide invaluable assistance in arriving at the appropriate treatment decision.

PMID:24849199 | PMC:PMC5176346 | DOI:10.1007/s00268-014-2592-1

Medical futility: Turning to the ethics committee.

Tue, 01 Jan 2013 05:00:00 +0000

Oncology Nurse Advisor; 01/01/2013
The article discusses issues related to ethic committee consultation in the hospital setting. It describes the case of an eight-year-old male admitted for severe anemia and comments on the ethics committee's written report on this patient which implies that patients who enter a hospital is surrendering ultimate control of their care to those providing it despite the efforts of advanced directives and written consents intended to do the opposite.
(AN 88088575); ISSN: 2154350X
CINAHL Complete

Medical futility: legal and ethical analysis

Tue, 11 Dec 2012 00:00:00 +0000

Virtual Mentor. 2007 May 1;9(5):375-83. doi: 10.1001/virtualmentor.2007.9.5.msoc1-0705.

NO ABSTRACT

PMID:23217998 | DOI:10.1001/virtualmentor.2007.9.5.msoc1-0705

Is a determinination of medical futility ethical?

Tue, 01 May 2012 04:00:00 +0000

Professional Case Management; 05/01/2012
Medical futility is a timely topic and one fraught with ethical implications. Medical futility is a term used to describe medical interventions that are expected to result in little or no benefit to a paitent. This Editorial examines some considerations and applications of medical futility to a specific patient or treatment, the ramifications of the use of the term futility, and its effects on physician-patient communication and the role of the health care administrator. Invoking medical futility is fraught with areas of vulnerability and implications in ethical decision making. Of concern is whether the treatment will cause more harm than good (nonmaleficence), whether it respects patients' goals and desires (autonomy), and whether the interests of patients, society, and the organizations are served (justice).
(AN 108185703); ISSN: 19328087
CINAHL Complete

Is a determination of medical futility ethical?

Wed, 11 Apr 2012 00:00:00 +0000

Prof Case Manag. 2012 May-Jun;17(3):103-6. doi: 10.1097/NCM.0b013e31824d6720.

ABSTRACT

Medical futility is a timely topic and one fraught with ethical implications. Medical futility is a term used to describe medical interventions that are expected to result in little or no benefit to a patient. This Editorial examines some considerations and applications of medical futility to a specific patient or treatment, the ramifications of the use of the term futility, and its effects on physician-patient communication and the role of the health care administrator. Invoking medical futility is fraught with areas of vulnerability and implications in ethical decision making. Of concern is whether the treatment will cause more harm than good (nonmaleficence), whether it respects patients' goals and desires (autonomy), and whether the interests of patients, society, and the organization are served (justice).

PMID:22488337 | DOI:10.1097/NCM.0b013e31824d6720

Patient-originated futility insight: ethical right or ethical plight?

Tue, 05 Jul 2011 00:00:00 +0000

J Vasc Surg. 2011 Jul;54(1):237-9. doi: 10.1016/j.jvs.2011.05.004.

NO ABSTRACT

PMID:21722831 | DOI:10.1016/j.jvs.2011.05.004

No Chance, No Value, or No Way: Reassessing the Place of Futility in Health Care and Bioethics.

Wed, 01 Jun 2011 04:00:00 +0000

Journal of Bioethical Inquiry; 06/01/2011
(AN 104714293); ISSN: 11767529
CINAHL Complete

Medical futility: a commonly used and potentially abused idea in medical ethics

Tue, 08 Mar 2011 00:00:00 +0000

Br J Hosp Med (Lond). 2011 Feb;72(2):96-9. doi: 10.12968/hmed.2011.72.2.96.

ABSTRACT

Hospital doctors frequently invoke the idea of medical futility in making decisions regarding end-of-life care. This concept of futility will be reviewed and the differing definitions and how it relates to other important principles in biomedical ethics discussed.

PMID:21378616 | DOI:10.12968/hmed.2011.72.2.96

Medical futility: a commonly used and potentially abused idea in medical ethics.

Tue, 01 Feb 2011 05:00:00 +0000

British Journal of Hospital Medicine (17508460); 02/01/2011
Hospital doctors frequently invoke the idea of medical futility in making decisions regarding end-of-life care. This concept of futility will be reviewed and the differing definitions and how it relates to other important principles in biomedical ethics discussed.
(AN 104843095); ISSN: 17508460
CINAHL Complete

Ethics rounds. Symbolic resuscitation, medical futility, and parental rights

Wed, 15 Sep 2010 00:00:00 +0000

Pediatrics. 2010 Oct;126(4):769-72. doi: 10.1542/peds.2010-1379. Epub 2010 Sep 13.

NO ABSTRACT

PMID:20837595 | DOI:10.1542/peds.2010-1379

A model for ethical decision making in cases of patient futility.

Thu, 01 Jul 2010 04:00:00 +0000

Clinical Nurse Specialist: The Journal for Advanced Nursing Practice; 07/01/2010
(AN 105046432); ISSN: 08876274
CINAHL Complete

A model for ethical decision making in cases of patient futility

Tue, 08 Jun 2010 00:00:00 +0000

Clin Nurse Spec. 2010 Jul-Aug;24(4):189-90. doi: 10.1097/NUR.0b013e3181e360ac.

NO ABSTRACT

PMID:20526117 | DOI:10.1097/NUR.0b013e3181e360ac

Workshop: the ethics of futility in oncology settings...7th EONS Spring Convention in partnership with V&VN, 15-16 April 2010, The Hague, The Netherlands

Fri, 02 Apr 2010 04:00:00 +0000

European Journal of Oncology Nursing; 04/02/2010
(AN 105073613); ISSN: 14623889
CINAHL Complete