Medical futility and the critically ill patient.

Abstract

Today, the world of critical care medicine has given us the capabilities to accomplish things that were only dreamed of a few decades ago. When combined with the increasing importance of patient autonomy and economics in healthcare, these new capabilities have caused conflicts about what is too little, and what is too much. Medical futility becomes an issue whenever these conflicts arise. Understanding how to deal with issues surrounding futility begins with defining it. A firm definition is not possible or desirable, but revolves around the probability of being able to achieve a patient's goal with modern medicine. Establishing this understanding between the patient and their family (team), and the healthcare team, is dependent on trust between the two. It must be recognized that there are many reasons for families to not trust healthcare professionals and that these reasons need to be explored and dealt with. Sometimes conflicts regarding predictions and economics need to be addressed. Once trust is established a goal for a course of medical treatment should be discussed from the patient's perspective. This discussion should involve the physician's best judgement as to the chances of achieving this goal, and what type of discomfort or indignity, if any, the patient may experience. Only after these have been clearly discussed can decisions regarding medical futility be made. To date, the U. S. Courts have refused to grant physicians and hospitals the power to override the opinions of family members on matters of futility. However, with time, a consensus of public opinion should influence decisions regarding medical futility.