Perceptions of Futility in Interventional Radiology: A Multipractice Systematic Qualitative Analysis

Ethical Issuing Arising Around Biliary Interventions

“…In fact, a recent study of IRs' perceptions of futility found this to be one of the most common scenarios in the specialty perceived as futile. 12 The study also found that IRs often struggle with these requests, perhaps more than other specialties due to the minimally invasive nature of our procedures and difficulties navigating these requests as a consultant service, particularly in certain practice settings. Many IRs described still performing procedures perceived as potentially inappropriate because of an array of cultural factors such as not wanting to upset the referring team or lose referrals such as in the case above.…”

“…Some practices have even worked with administration to establish criteria for certain common requests that raise questions of futility such as percutaneous feeding tubes in patients with severe dementia. 12 If the IR in the case regularly received requests for multiple biliary drains in patients with obstructive jaundice and end-stage malignancy, it may be worth establishing a multidisciplinary working group to discuss how best to manage these cases and ultimately establish an institutional policy. At an individual level, the authors suggest following the steps proposed in the previously mentioned study of perceptions of futility in IR, which draw upon multisociety position statements.…”

“…At an individual level, the authors suggest following the steps proposed in the previously mentioned study of perceptions of futility in IR, which draw upon multisociety position statements. 12,16,22 Briefly, the IR would first discuss the concern with the referring team. If disagreement persisted, the IR would suggest a multidisciplinary goals of care discussion with the family with or without the assistance of palliative care or an ethics committee as a mediator.…”

The Ethics of Trauma Care: What Interventional Radiologists Should Know

“…Another salient set of ethical challenges involve requests for potentially inappropriate procedures, those that are unlikely to achieve a meaningful outcome. 13 These requests are not uncommon in IR, 14 particularly in the setting of a chronic critical illness such as requests for multiple biliary drains in the setting of malignant obstructive jaundice or gastrostomy tube in the setting of severe dementia. It the setting of acute trauma, IRs may be more willing to attempt a heroic intervention even with marginal chance of benefit if it is the patient's only option.…”

“…It the setting of acute trauma, IRs may be more willing to attempt a heroic intervention even with marginal chance of benefit if it is the patient's only option. 14 However, this must be weighed against the just use of available resources and an ethical obligation to avoid futile care-interventions that are clearly unable to achieve the intended outcome. For example, the trauma patient with multiple gunshot wounds, including through the skull, who is actively being coded in the trauma bay is unlikely to survive the trip to the fluoroscopy suite let alone the requested embolization.…”