Futility-of-care decisions in the treatment of moribund intensive care patients in a developing country

Reasons doctors provide futile treatment at the end of life: a qualitative study

“…One recent US survey found that critical care specialists perceived that 11% of patients in their unit received futile treatment, and a further 8.6% were probably given futile treatment 17. There have been consistent findings in other countries 6 10 11 18–21…”

“…To achieve this, we must first understand the complex reasons why such treatment is provided. The literature points to a range of drivers of futile treatment at the end of life, emphasising family and patient request,6–11 13–16 19 24 25 poor communication with patients and families,6 7 9 11 15 19 21 24–26 lack of knowledge about patient wishes,12 13 15 24 conflict with colleagues10 11 13–15 24 25 and legal concerns 6 8–10 13 15 16 19 20. Some also suggest that doctors are responsible for futile treatment (although to a lesser degree than patients or families)7 11 15 19 21 24 27 and a few point to institutional reasons such as time pressure 16 24…”

The Durban World Congress Ethics Round Table IV: Health care professional end-of-life decision making

“…There are, however large differences in the practice of WH/WD in different parts of the world as evidenced by responses to several surveys that have explored physicians' practice and ethical views on the subject [13][14][15][16][17][18][19][20]. This self-reported variation in the pattern of practice of health care practitioners has been confirmed by observational studies that also demonstrate regional variations in practice [4][5][6][7][8][9][10][11][12]. Although guidelines for some jurisdictions do exist, [21][22][23][24][25] and are often useful, they sometimes lack sufficient detail to guide daily practice and seldom consider the variability inevitably introduced by cultural and regional differences.…”

“…Life-support technology has advanced, so that it is now possible to maintain vital organ function, despite the realization that a return of the patient to reasonable health and an acceptable quality of life are no longer possible. When a return to reasonable health is no longer possible, it has become common clinical practice worldwide for ICU staff to limit life-sustaining treatments (LSTs) by withholding (WH) or withdrawing (WD) LSTs [4][5][6][7][8][9][10][11][12]. There are, however large differences in the practice of WH/WD in different parts of the world as evidenced by responses to several surveys that have explored physicians' practice and ethical views on the subject [13][14][15][16][17][18][19][20].…”

Condutas de limitação terapêutica em pacientes internados em Unidade de Terapia Intensiva

“…Em um centro na África do Sul essa prevalência foi de 86,7% 16 . Hariharan e col. num estudo realizado numa UTI cirúrgica em Barbados, na América Central, encontraram que 30% dos pacientes que foram a óbito entre julho de 1999 e junho de 2002 recebiam tratamento agressivo, mesmo após este tratamento ser considerado fútil devido ao prognóstico reservado 20 . No Brasil, Moritz e col. demonstraram que a recusa ou a suspensão de tratamentos foram constatados em 32% dos óbitos em UTI de um hospital universitário e a futilidade da terapia foi considerada como principal motivo em 100% destes casos 21 .…”