When ICU Treatment Becomes Futile

Abstract

Many patients admitted to the intensive care unit (ICU) have no hope of meaningful survival and receive "futile" therapy. When a patient is no longer capable of deciding (so that autonomy is no longer applicable), giving futile treatment is against the three other key ethical principles: beneficence, non-maleficence, and distributive justice. Continuing futile treatments impacts on the patient and his/her family, but also on other patients and society as a whole. In such situations, the goal of intensive care should no longer be to maximize a patient's chances of a good quality of life on discharge but rather to provide them with a dignified and comfortable death. Once a decision has been made that intervention is futile, all on-going treatment should thus be withdrawn except for comfort measures. Good and continuing communication with the family and all members of the healthcare team is an essential aspect of insuring the best possible dying process. In this article, we will explore this complex area and try to provide answers to some of the difficult issues involved, including how futility can be recognized, who should determine that further treatment is futile, and what should be done once it has been decided that further treatment is futile in a particular patient.

When is it Worth Starting a Risky and Uncomfortable Treatment in Critically Ill Patients? Gender, Education and Professional Involvement in Critical Care Impact on the Opinion

“…[31] Nurses feel better prepared for end of life decisions in critical care. [32] Taken together, our data support the notion of different viewpoint of different groups of health care professionals on treatment decisions in critical care and support the concept that especially in critical care, team discussions and team decisions are necessary and bene cial for team members and patients [9] as part of a bioethical framework to guide the decision-making process in critical care. [1] Interestingly, a proportion of respondents has different opinions on necessary survival chances and acceptable risks for themselves, relatives and patients.…”

“…[6] This requires on the one hand the accurate prediction of outcome after the intervention, which is not possible in many cases. [9] On the other hand, prediction of "appropriate" positive prospect of a treatment also contains a personal component and may have a high individual variability in the interpretation of a "livable" outcome. Predictions of outcome and quality of life by doctors and nurses are inaccurate with false optimistic as well as false pessimistic results as compared to the judgements of surviving patients 6 months after discharge.…”

Perceptions of intensive care unit nurses of therapeutic futility: A scoping review

“…When the critically ill patient loses decision-making power, the principle of autonomy becomes impossible to apply and the implementation of futile interventions violates the ethical principles of beneficence, nonmaleficence, and justice. 13 Therapeutic futility is associated with a highly complex ethical process, 20 for which reason it is difficult to present a definition. 21 When experiencing situations of therapeutic futility in adult intensive care units, it is imperative to know and understand the perceptions of individuals and families regarding the decision to limit or continue treatment.…”

“…14 Without a clear and understandable definition, some authors consider the diagnosis of futility to be purely medical, while others claim that this concept is a moral judgment in which the person and family can play an important role in deciding what is futile and what is not. 13 Alongside therapeutic futility, intensive care unit health professionals, particularly physicians and nurses, often identify concerns about therapeutic obstinacy, recognizing its responsibility for exacerbating ethical conflicts when providing care to the person in critical health conditions.…”

“…17 In intensive care units, ethical debates over these conceptions are frequent, since it is admitted that in these contexts many people have no significant probability of survival and are subject to the implementation of futile therapies. 13 In addition to all the consequences for the person and the family, it is argued that therapeutic futility may negatively impact professional satisfaction and lead nurses in intensive care units to emotional exhaustion. 18…”