Moral Intuitions About Futility as Prompts for Evaluating Goals in Mental Health Care

Abstract

Mental health professionals' moral intuitions about futility should prompt reevaluation of goals of care and care plans. Mostly, it will suffice to improve the care plan and/or slightly adjust the goal of care (eg, lower expectations), which is standard practice. Sometimes, however, all care plans that seek to reduce core symptoms (ie, that pursue a curative goal) are most likely futile and thus should not be imposed. Here, it may be in the patient's best interest to change the goal of care toward palliation (ie, harm reduction, relief of suffering, and best possible quality of life). Thus, futility can function as a moral counterweight to the duty to treat, helping mental health professionals find the right balance between over-and undertreatment.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity. Moral Intuitions -I wouldn't want this for myself. -Treatment is making my patient suffer horribly.-There is no good option here.-No matter what I do, I don't think my patient is going to get better.-I have no choice but to use coercion.-I feel that we're only making matters worse.-I wouldn't be surprised if my patient died this year.Thoughts like these and associated feelings of unease, helplessness, and being stuck are not uncommon among mental health professionals, especially those caring for persons living with severe and persistent mental illness (SPMI). 1,2 Typically, these concerns are dismissed or attributed to burnout, lack of training or experience, or unprofessional pessimism. Instead, this article explores these concerns as moral intuitions with the potential to improve care for persons living with SPMI.Moral intuitions are thoughts that incline one toward a certain moral response (eg, We should not continue this patient's current treatment) and arise without conscious effort.