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

Willmott, Lindy; White, Benjamin P.; Gallois, Cindy; Parker, Malcolm; Graves, Nicholas; Winch, Sarah; Callaway, Leonie K.; Shepherd, Nicole; Close, Eliana

doi:10.1136/medethics-2016-103370

Cited by 96 publications

(90 citation statements)

References 44 publications

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“…Participants described defaulting to commence or continue resuscitation in situations of uncertainty or inexperience. Other studies have associated prognostic uncertainty with the provision of medically futile treatment and noted that confidence in determining futility21 and withholding or terminating curative treatment22 appeared to increase with experience. Research exploring reasons for non-compliance with termination of resuscitation protocols noted that lack of family emotional preparedness23 or family distress were commonly cited discretionary rationales 8…”

Section: Discussionmentioning

confidence: 99%

Beyond prognostication: ambulance personnel’s lived experiences of cardiac arrest decision-making

2018

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This unique, exploratory study provides new insights into ambulance personnel's experiences of prehospital resuscitation decision-making. Prognostication in out-of-hospital cardiac arrest is known to be challenging, but results from this study suggest that confidence in a poor prognosis for the cardiac arrested patient is only part of the resuscitation decision-making picture. Results suggest ambulance personnel may benefit from greater educational preparation and mentoring in managing the scene of a death to avoid inappropriate or prolonged resuscitation efforts.

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Section: Discussionmentioning

confidence: 99%

Beyond prognostication: ambulance personnel’s lived experiences of cardiac arrest decision-making

2018

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“…Recently, Willmott et al have reported why doctors provide futile treatments at the end of life 24. The drivers are multiple and powerful.…”

Section: Avoiding Nbts: Obstacles In the Waymentioning

confidence: 99%

Futility and appropriateness: challenging words, important concepts

Taylor

Lightbody

2018

Postgraduate Medical Journal

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The provision of healthcare is being challenged by a 'perfect storm' of forces including an increasing population with multiple comorbidities, high expectations and resource limitations, and in the background, the pre-eminence of the 'curative medical model'. Non-beneficial (futile) treatments are wasteful and costly. They have a negative impact on quality of life especially in the last year of life. Among professionals, frequent encounters with futility cause moral distress and demoralisation. The factors that drive non-beneficial treatments include personal biases, patient-related pressures and institutional imperatives. Breaking loose from the perceived necessity to deliver non-beneficial treatment is a major challenge. Curative intent should give way to such that curative and palliative interventions are valued equally. Goals of treatment should be shaped by illness trajectory, the risk of harms as well as potential benefits and patient preferences. This strategy should be reflected in professional training and the design of acute services.

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“…Advances in medicine allow life to be prolonged, frequently in poor health, raising concerns over whether scarce health resources are being used wisely 1 2. Yet, as illustrated by the recent case of Charlie Gard,3 at the individual level, a decision to withhold or withdraw life-sustaining treatment can be difficult, and patients (or their substitute decision makers) may want treatment doctors believe is inappropriate 4. There are two distinct, but related, ethical rationales that a doctor could rely on to refuse such treatment 3 5–7.…”

Section: Introductionmentioning

confidence: 99%

“…This paper addresses this gap. Drawing on a larger project looking at how doctors conceptualise futile treatment,20 and the reasons they provide it,4 it reports on how doctors view the relationship between futility and resources, both conceptually and in their descriptions of their practice.…”

Section: Introductionmentioning

confidence: 99%

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

White

Willmott

et al. 2019

J Med Ethics

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

Cited by 96 publications

References 44 publications

Beyond prognostication: ambulance personnel’s lived experiences of cardiac arrest decision-making

Beyond prognostication: ambulance personnel’s lived experiences of cardiac arrest decision-making

Futility and appropriateness: challenging words, important concepts

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

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