Meaningful futility: requests for resuscitation against medical recommendation

Abstract

‘Futility’ is a contentious term that has eluded clear definition, with proposed descriptions either too strict or too vague to encompass the many facets of medical care. Requests for futile care are often surrogates for requests of a more existential character, covering the whole range of personal, emotional, cultural and spiritual needs. Physicians and other practitioners can use requests for futile care as a valuable opportunity to connect with their patients at a deeper level than the mere biomedical diagnosis. Current debate around Canada’s changing regulatory and legal framework highlights challenges in appropriately balancing the benefits and burdens created by requests for futile care.

Medical futility regarding cardiopulmonary resuscitation in in-hospital cardiac arrests of adult patients: A systematic review and Meta-analysis

“…44,52 While multiple theoretical articles from the field of medical ethics describe specific concepts of medical futility, researchers closer aligned to clinical practice often emphasize the difficulty of determining and implementing such concepts. 15,[54][55][56][57] In public and academic discussions about futility, multiple fundamental issues have been raised that hinder an international consensus definition. These include ethical questions and concerns, societal values, cultural beliefs, legal challenges, and clinicians' responsibilities.…”

“…59 Still, the potential influence of physicians' value judgments, beliefs and assumptions about the patient's quality of life and the limited number of studies regarding the impact of invasive life-prolonging measures in intensive care on short-and longterm outcome make decisions on qualitative futility challenging in routine care. 15,[54][55]57,59 Only four studies 39,40,44,52 assessed the code status in patients in whom resuscitation was determined futile. The rates of DNR orders in these studies varied due to the high heterogeneity of patient samples, definitions and assessments of futility, making interpretation difficult.…”

Addressing Futility: A Practical Approach

“…Providers should openly acknowledge these fears while clearly stating the limitations and harms of CPR. Furthermore, families should be reassured that a DNR order changes nothing about how the team will approach other aspects of care ( 32 ).…”

Medical Futility or Persistent Therapy? A Dispute over the Terms and Definitions in the Polish Context

“…The most narrowly defined type of medical futility is referred to as "physiological futility" (Vivas, Carpenter, 2020), wherein physicians do not make any evaluative assessment that a treatment's effect is not worthwhile. There is no normative (evaluative) disagreement; the physicians can ascertain physiological futility based on their clinical knowledge.…”