Doctors’ perceptions of how resource limitations relate to futility in end-of-life decision making: a qualitative analysis

Abstract

ObjectiveTo increase knowledge of how doctors perceive futile treatments and scarcity of resources at the end of life. In particular, their perceptions about whether and how resource limitations influence end-of-life decision making. This study builds on previous work that found some doctors include resource limitations in their understanding of the concept of futility.SettingThree tertiary hospitals in metropolitan Brisbane, Australia.DesignQualitative study using in-depth, semistructured, face-to-face interviews. Ninety-six doctors were interviewed in 11 medical specialties. Transcripts of the interviews were analysed using thematic analysis.ResultsDoctors’ perceptions of whether resource limitations were relevant to their practice varied, and doctors were more comfortable with explicit rather than implicit rationing. Several doctors incorporated resource limitations into their definition of futility. For some, availability of resources was one factor of many in assessing futility, secondary to patient considerations, but a few doctors indicated that the concept of futility concealed rationing. Doctors experienced moral distress due to the resource implications of providing futile treatment and the lack of administrative supports for bedside rationing.ConclusionsDoctors’ ability to distinguish between futility and rationing would be enhanced through regulatory support for explicit rationing and strategies to support doctors’ role in rationing at the bedside. Medical policies should address the distinction between resource limitations and futility to promote legitimacy in end-of-life decision making.

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“…This taboo may partly explain why interestsbased and resource-based rationales for limiting lifesustaining treatment are not sufficiently distinguished in practice (Rubin and Truog 2017). Indeed, some doctors perceive that the concept of futility masks both conscious and unconscious rationing (Close et al 2019b), the "withholding … of a medically beneficial service because of that service's cost to someone other than the patient" (Ubel and Goold 1997, 75). 1 Given that health resources are limited, rationing is necessary and justifiable, provided it is accomplished transparently using fair processes (Daniels 2000;Scheunemann and White 2011).…”