Futile treatment is treatment that has only a very low chance of achieving meaningful benefit for the patient in terms of: improving quality of life; sufficiently prolonging life of acceptable quality; or bringing benefits that outweigh the burdens of treatment.
Full Answer
What is “futility” in medicine?
“Futility means any treatment that, within a reasonable degree of medical certainty, is seen to be without benefit to the patient, as when the treatment at issue is seen as ineffective with regard to a clinical problem that it would ordinarily be used to treat.” 3
When is a treatment futile?
Some physicians summarily claim a treatment is futile without knowing the relevant outcome data. There is no unanimity regarding the statistical threshold for a treatment to be considered futile. There is often serious disagreement between physicians and families regarding the benefits to the patient of continued treatment.
How can we overcome the need for medical futility?
Proactive, effective, and open communication early on in the treatment plan may circumvent the need for the medical futility process. The question of what's “futile” often can't be answered until clear goals of treatment are defined.
Is medical futility ethically controversial?
Medical futility remains ethically controversial for several reasons. Some physicians summarily claim a treatment is futile without knowing the relevant outcome data. There is no unanimity regarding the statistical threshold for a treatment to be considered futile.
What is the meaning of futile treatment?
“Futile treatment: Treatment evaluated by the healthcare team, family, or both, as being nonbeneficial or harmful to a dying patient.”
When should a medical treatment be considered futile?
Some scholars tried to quantify medical futility, defining it as less than a 1% chance of success. Others set different thresholds, such as less than 2% or 5% success rates. Although attractive for its concreteness, quantitative methods are unsatisfactory for the small percentage of patients who benefit from treatment.
What is a futile case?
In general, a medically futile treatment is. an action, intervention, or procedure that might be physiologically effective in a given case, but cannot benefit the patient, no matter how often it is repeated.
How is medical futility determined?
Who decides when a particular treatment is futile? Generally the term medical futility applies when, based on medical data and professional experience, a treating health care provider determines that an intervention is no longer beneficial.
What is an example of medical futility?
Instead, it refers to a particular intervention at a particular time, for a specific patient. For example, rather than stating, “It is futile to continue to treat this patient,” one would state, “CPR would be medically futile for this patient.”
Who determines medical futility?
On the other hand, the concept of futility is based on value judgments made by different parties, such as patients, family members, and healthcare professionals (2, 22, 23). Hence, it cannot be determined and directly measured based solely on physiological parameters.
What is a medical futility law?
The term medical futility refers to a physician's determination that a therapy will be of no benefit to a patient and therefore should not be prescribed. But physicians use a variety of methods to make these determinations and may not arrive at the same conclusions.
Should doctors be able to refuse demands for futile treatment?
Patients themselves have a right to provide input into what would constitute a "benefit" for them, but physicians should be able to decide when a particular treatment is futile based on their knowledge of the treatment's effects and its likely impact on a patient's quality of life.
What is the futility law?
The qualitative approach to futility is based on an assumption that physicians should not be required to provide treatments to achieve objectives that are not worthwhile medical goals. For example, a physician may argue that it is futile to attempt resuscitation of a patient in a permanent vegetative state.
What is the nurse's role in determining what is medically futile?
To decide on the futility or efficacy of care services, we should inquire patients about withdrawing or withholding care provision. Based on their findings, nurses play a key role in the continuation or discontinuation of therapeutic measures and have significant impacts on the attitudes of patients and their families.
Why is medical futility controversial?
Medical futility remains ethically controversial for several reasons. Some physicians summarily claim a treatment is futile without knowing the relevant outcome data. There is no unanimity regarding the statistical threshold for a treatment to be considered futile.
Would you recommend or give life sustaining therapy when you judge that it's futile?
In surveying physicians, Medscape researchers asked, "Would you ever recommend or give life-sustaining therapy when you judged that it was futile?" Nearly 5300 physicians answered the question: 23.6% said yes, they would recommend or continue to give care they knew to be futile, while 37.0% said they would not.
What is futile nursing care?
Futile care was defined as useless and inconclusive care, leading to the squandering of financial resources and patient/nurse discomfort, with both nursing and medical aspects.
In what circumstances are medical treatments not indicated?
In what circumstances are medical treatments not indicated? No scientifically demonstrated effect. Known to be efficacious in general but may not have the usual effect on some patients because of their presentation of the disease or their constitution.
Which best represents Trotter's definition of futility?
Trotter's Definition of futility. Three parts: a goal, an action or activity aimed at achieving the goal, and virtual certainty that the action will fail.
What is non beneficial treatment?
Futile or non-beneficial treatment is not defined in law, but is often used to describe treatment which is of no benefit, cannot achieve its purpose, or is not in the person's best interests. Health professionals generally decide whether particular treatment for a person is futile or non-beneficial.
What does "futile" mean in medical terms?
Instead, it refers to a particular intervention at a particular time, for a specific patient. For example, rather than stating, “It is futile to continue to treat this patient,” one would state, “CPR would be medically futile for this patient.”
What is medical futility?
What is "medical futility"? "Medical futility" refers to interventions that are unlikely to produce any significant benefit for the patient. Two kinds of medical futility are often distinguished: Quantitative futility, where the likelihood that an intervention will benefit the patient is exceedingly poor, and.
Why do we need futile intervention?
In some instances, it may be appropriate to continue temporarily to make a futile intervention available in order to assist the patient or family in coming to terms with the gravity of their situation and reaching closure. For example, a futile intervention for a terminally ill patient may in some instances be continued temporarily in order to allow time for a loved one arriving from another state to see the patient for the last time. However, futile interventions should not be used for the benefit of family members if this is likely to cause the patient substantial suffering, or if the family’s interests are clearly at odds with those of the patient.
What should physicians consider when making futility judgments?
Physicians should follow professional standards, and should consider empirical studies and their own clinical experience when making futility judgments. They should also show sensitivity to patients and families in carrying out decisions to withhold or withdraw futile interventions.
What is the ethical requirement for a patient to choose from among medically acceptable treatment options?
Although the ethical requirement to respect patient autonomy entitles a patient to choose from among medically acceptable treatment options (or to reject all options), it does not entitle patients to receive whatever treatments they ask for. Instead, the obligations of physicians are limited to offering treatments that are consistent with professional standards of care and that confer benefit to the patient.
What is futility in clinical practice?
Making a judgment of futility requires solid empirical evidence documenting the outcome of an intervention for different groups of patients. Futility establishes the negative determination that the evidence shows no significant likelihood of conferring a significant benefit. By contrast, treatments are considered experimental when empirical evidence is lacking and the effects of an intervention are unknown.
What is qualitative futility?
Qualitative futility, where the quality of benefit an intervention will produce is exceedingly poor. Both quantitative and qualitative futility refer to the prospect that a specific treatment will benefit (not simply have a physiological effect) on the patient.
What is medical futility?
Medical futility: definition, determination, and disputes in critical care. Physicians may employ the concept of medical futility to justify a decision not to pursue certain treatments that may be requested or demanded by patients or surrogates. Medical futility means that the proposed therapy should not be performed because available data show ...
Why is futility important in medical care?
Physicians may employ the concept of medical futility to justify a decision not to pursue certain treatments that may be requested or demanded by patients or surrogates. Medical futility means that the proposed therapy should not be performed because available data show that it will not improve the patient's medical condition. Medical futility remains ethically controversial for several reasons. Some physicians summarily claim a treatment is futile without knowing the relevant outcome data. There is no unanimity regarding the statistical threshold for a treatment to be considered futile. There is often serious disagreement between physicians and families regarding the benefits to the patient of continued treatment. Medical futility has been conceptualized as a power struggle for decisional authority between physicians and patients/surrogates. Medical futility disputes are best avoided by strategies that optimize communication between physicians and surrogates; encourage physicians to provide families with accurate, current, and frequent prognostic estimates; assure that physicians address the emotional needs of the family and try to understand the problem from the family's perspective; and facilitate excellent palliative care through the course of the illness. Critical care physicians should support the drafting of state laws embracing futility considerations and should assist hospital policymakers in drafting hospital futility policies that both provide a fair process to settle disputes and embrace an ethic of care.
Is medical futility ethical?
Medical futility remains ethically controversial for several reasons. Some physicians summarily claim a treatment is futile without knowing the relevant outcome data. There is no unanimity regarding the statistical threshold for a treatment to be considered futile.
What does "futile" mean in medical terms?
Instead, it refers to a particular intervention at a particular time, for a specific patient. For example, rather than stating, “It is futile to continue to treat this patient,” one would state, “CPR would be medically futile for this patient.”
What is futility in medicine?
"Medical futility" refers to interventions that are unlikely to produce any significant benefit for the patient. Two kinds of medical futility are often distinguished: 1 Quantitative futility, where the likelihood that an intervention will benefit the patient is exceedingly poor, and 2 Qualitative futility, where the quality of benefit an intervention will produce is exceedingly poor.
What is the ethical requirement for a patient to choose from among medically acceptable treatment options?
Although the ethical requirement to respect patient autonomy entitles a patient to choose from among medically acceptable treatment options (or to reject all options), it does not entitle patients to receive whatever treatments they ask for. Instead, the obligations of physicians are limited to offering treatments that are consistent with professional standards of care and that confer benefit to the patient.
What is medical futility?
What is "medical futility"? "Medical futility" refers to interventions that are unlikely to produce any significant benefit for the patient. Two kinds of medical futility are often distinguished: Quantitative futility, where the likelihood that an intervention will benefit the patient is exceedingly poor, and.
Why do we need futile intervention?
In some instances, it may be appropriate to continue temporarily to make a futile intervention available in order to assist the patient or family in coming to terms with the gravity of their situation and reaching closure. For example, a futile intervention for a terminally ill patient may in some instances be continued temporarily in order to allow time for a loved one arriving from another state to see the patient for the last time. However, futile interventions should not be used for the benefit of family members if this is likely to cause the patient substantial suffering, or if the family’s interests are clearly at odds with those of the patient.
What is futility in clinical practice?
Making a judgment of futility requires solid empirical evidence documenting the outcome of an intervention for different groups of patients. Futility establishes the negative determination that the evidence shows no significant likelihood of conferring a significant benefit. By contrast, treatments are considered experimental when empirical evidence is lacking and the effects of an intervention are unknown.
Is there a correlation between age and futility?
Futility has no necessary correlation with a patient’s age. What determines whether a treatment is futile is whether or not the treatment benefits the patient. In cases where evidence clearly shows that older patients have poorer outcomes than younger patients, age may be a reliable indicator of patient benefit, but it is benefit, not age, that supports a judgment of medical futility. For patients of all ages, health care professionals should advocate for medically beneficial care, and refrain from treatments that do not help the patient.
What is the importance of communication in medical futility?
Equally important is crucial communication, which should occur early on in the patient's care, between the healthcare team, the patient, and the family. Ideally, all parties are informed and on common ground for the short- and long-term treatment plan, through straightforward efforts in communication, and upon initiation of care.
What is the importance of communication, understanding treatment goals, and developing guidelines to address medical futility?
Valuing communication, understanding treatment goals, and developing guidelines to address medical futility will move organization s toward a greater understanding of medical futility and improved patient care.
Why is it important to have a framework for nursing?
Having a framework or guideline in place will provide direction and potentially reduce unnecessary conflicts, which can arise among healthcare providers, patients, families, and community.
Is medical futility a vague concept?
Each definition can pose its own challenges and be fraught with dissension upon attempts to move from theory to operational implementation in the clinical arena. Indeed, it may seem futile to attempt to define medical futility.
