Families and futility: Forestalling demands for futile treatment

Journal of Clinical Ethics

Volumn 16, Issue 4, 2005, Pages 345-354

  Hardwig, John ^a  

^a UNIVERSITY OF TENNESSEE   (United States)

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[No Author keywords available]

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EID: 31544479056     PISSN: 10467890     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (11)

1. P.R. Helft, M. Siegler, and J. Santos, "The Rise and Fall of the Futility Movement," New England Journal of Medicine 343, no. 4 (2000): 293-6.
2. P.R. Helft, M. Siegler, and J. Santos, New England Journal of Medicine Ibid., 293.
3. There is also a fourth approach to the problem of futility that should at least be mentioned in passing. We could be more open about the fact that one of the main reasons healthcare professionals find futile treatment so demoralizing is that it is a simply horrible use of scarce medical resources, including themselves. Though we may legitimately claim that the futility problem is different from the problem of rationing healthcare resources, few physicians and nurses get too upset about requests for simple, relatively inexpensive treatments that don't work - antibiotics for viruses, large doses of vitamins to prevent cancer, alternative medicines used in conjunction with standard therapies, etc. If we honestly admitted that we ration healthcare all of the time, we could fold the futility problem into the problem of scarce, pooled healthcare resources. Then we could refuse to deliver futile treatment simply because there are much better uses of the available resources. "We do not prolong life we believe to be permanently unconscious because we believe it is much better to devote those medical resources to preserving the life of conscious patients." Although I believe this approach also has merit, I will focus in this article on approaching the problem of futility through talking with patients and families.
4. See note 2 above, p. 296.
5. J. Hardwig, "The Problem of Proxies with Interests of Their Own," The Journal of Clinical Ethics 4, no. 1 (Spring 1993): 20-7;
6. J. Hardwig, "What About the Family?" Hastings Center Report 20, no. 2 (March-April 1990): 5-10;
7. J. Hardwig, "SUPPORT and the Invisible Family," Hastings Center Report 25, no. 6 (November-December 1995): S23-5.
8. Hospice care is a noteworthy exception. Hospice continues to care for the "survivors" after the patient has died.
9. J. Hardwig, "Spiritual Issues at the End of Life: A Call for Discussion," Hastings Center Report 30, no. 2 (March-April 2000): 28-30.
10. Note that we happily pursue medical solutions to all kinds of nonmedical family problems without feeling any sense that medicine is thereby perverted. Think of cosmetic surgery, for example. If a husband's dislike of the crow's feet around the eyes of his 40-year-old wife is not an inappropriate reason to use medical resources, why is the spiritual crisis of a dying patient's husband not an equally appropriate use of them? We are faced with the difficult question of which nonmedical needs pervert medicine. The answer to this question cannot be that patients themselves pay for cosmetic surgery, for that would draw a connection between two problems that we have insisted are distinct - the problem of futility and the problem of scarce, pooled resources.
11. Needless to say, this is not an argument for converting ICUs into hospice units. But it may be a plea for returning ICUs to their proper mission of helping those who can be restored to a full-enough functioning to be discharged from the ICU.