The medical futility experience of nursing professionals in Greece

Abstract

Background Providing futile medical care is an ever-timely ethical problem in clinical practice. While nursing personnel are very closely involved in providing direct care to patients nearing the end of life, their role in end-of-life decision-making remains unclear. Methods This was a prospective qualitative study conducted with experienced nursing professionals from December 2020 through May 2021. Individual in-depth qualitative interviews were conducted with sixteen participants. We performed a thematic analysis of the data. Results Importantly, many participants were half-hearted in their attitude towards accepting or defining futile medical care. Furthermore, interestingly, a list of well-described circumstances emerged, under which the dying process is most likely to be a “bad and undignified” process. These circumstances reflected situations revolving around a) pain and suffering, b) treating patients with respect, c) the appearance and image of the patient body, and d) the interaction between patients and their relatives. Fear of legal action, the lack of a regulatory framework, physicians being pressured by (mostly uninformed) family members and physicians’ personal motives were reported as important reasons behind providing futile medical care. The nursing professional’s role as a participant in decisions on futile care and as a mediator between physicians and patients (and family members) was highlighted. Furthermore, the patient’s role in decisions on futile care was prioritized. The patient’s effort to keep themselves alive was also highlighted. This effort impacts nursing professionals’ willingness to provide care. Providing futile care is a major factor that negatively affects nursing professionals’ inner attitude towards performing their duties. Finally, the psychological benefits of providing futile medical care were highlighted, and the importance of the lack of adequately developed end-of-life care facilities in Greece was emphasized. Conclusions These findings enforce our opinion that futile medical care should be conceptualized in the strict sense of the term, namely, as caring for a brain-dead individual or a patient in a medical condition whose continuation would most likely go against the patient’s presumed preference (strictly understood). Our findings were consistent with prior literature. However, we identified some issues that are of clinical importance.

Limitation of Futile Therapy in the Opinion of Nursing Staff Employed in Polish Hospitals—Results of a Cross-Sectional Study

“…The analysis of the available literature reveals difficulties in defining the concept of futile therapy [ 17 , 18 ]. Many authors compare this task to the powerlessness of those who attempt to define art or love [ 19 ].…”

“…The importance of working out an agreement in an atmosphere of trust is emphasized in most publications on the discussed topic, with a particular emphasis on the need to train young doctors in the ability to conduct such a conversation [ 22 , 23 ]. The role of nurses in establishing a good relationship with the patient’s family is also widely discussed in the literature [ 17 , 24 ]. In Poland, too much importance is attached to the doctor, while reducing the role of the nursing staff.…”

Towards democratic institutions: Tronto’s care ethics inspiring nursing actions in intensive care

“…In this sense, we agree with Broom that there needs to be a 'greater transparency in relations of power, influence and obligation within the spaces where increasingly people are dying in contemporary societies, and for greater reflectiveness around how powerful relational forces shape people's experiences near death' (p. 156). 62 Therefore, this proposed 'democratized caring' in the context of EOL in ICUs means that every actor must have a say, 66 and nurses should be listened to by the attending physicians, who currently hold the decisional power. 67 If we rethink the power dynamics of doctors sitting atop the professional pyramid and instead value different opinions, we can create a political space where every concerned actor can contribute equally to achieve a suitable and consensual outcome.…”

“…Therefore, this proposed ‘democratized caring’ in the context of EOL in ICUs means that every actor must have a say, 66 and nurses should be listened to by the attending physicians, who currently hold the decisional power. 67 If we rethink the power dynamics of doctors sitting atop the professional pyramid and instead value different opinions, we can create a political space where every concerned actor can contribute equally to achieve a suitable and consensual outcome.…”

Ethical and Legal Issues in End-of-life Care: The Case of Life Prolongation

“…Society itself views death as a failure of healthcare. As is rightly noted in an editorial in The Lancet Respiratory Medicine: "Public perception of death and dying also needs to be addressed so that unrealistic expectations from medical treatments can be managed and death is not seen as a failure" [22].…”