Futile treatment – when is enough, enough?
Roy G. Beran
A B C D E * and J. A. Devereux F
A
B
C
D
E
F
Abstract
This paper examines two aspects of treatment decision making: withdrawal of treatment decisions made by a patient; and decisions to not proceed with treatment by a health professional. The paper aims to provide an overview of the law relating to the provision of treatment, then highlight the uncertainty as to the meaning of and costs associated with futile treatment.
The paper reviews the current legal and medical literature on futile treatment.
Continuing treatment which is futile is not in the patient’s best interests. Futility may be understood in both quantitative and qualitative terms. Recent legal cases have expanded the definition of futility to focus not on the nature of the treatment itself, but also on the health of the patient to whom treatment is provided.
As Australia’s population ages, there is likely to be an increased focus on the allocation of scarce health resources. This will, inevitably, place constraints on the number and variety of treatments offered to patients. The level of constraint will be felt acutely where a proposed treatment offers little clinical efficacy. It is time to try to understand and agree on a workable definition of futility.
Keywords: costs, consent to treatment, futility, health law, primary health care.
References
6 Tweeddale MG. Grasping the nettle--what to do when patients withdraw their consent for treatment: (a clinical perspective on the case of Ms B). J Med Ethics 2002; 28(4): 236-7 PMCID: PMC1733624.
| Crossref | Google Scholar | PubMed |
7 Wade DT, Kitzinger C. Making healthcare decisions in a person’s best interests when they lack capacity: clinical guidance based on a review of evidence. Clin Rehabil 2019; 33(10): 1571-85 Epub 6 June 2019. PMCID: PMC6745603.
| Crossref | Google Scholar | PubMed |
8 Wilkinson DJ, Savulescu J. Knowing when to stop: futility in the ICU. Curr Opin Anaesthesiol 2011; 24(2): 160-5 PMCID: PMC3252683.
| Crossref | Google Scholar | PubMed |
9 Schneiderman LJ, Jecker NS, Jonsen AR. Medical futility: response to critiques. Ann Intern Med 1996; 125(8): 669-74.
| Crossref | Google Scholar | PubMed |
10 O’Connor AE, Winch S, Lukin W, Parker M. Emergency medicine and futile care: Taking the road less travelled. Emerg Med Australas 2011; 23(5): 640-3 Epub 12 June 2011.
| Crossref | Google Scholar | PubMed |
11 Schneiderman LJ, Faber-Langendoen K, Jecker NS. Beyond futility to an ethic of care. Am J Med 1994; 96(2): 110-4.
| Crossref | Google Scholar | PubMed |
12 Parker M. Overstating values: medical facts, diverse values, biorthics and value-based medicine. Bioethics 2013; 27: 97-104.
| Crossref | Google Scholar | PubMed |
13 White B, Willmott L, Close E, et al. What does “futility” mean? An empirical study of doctors’ perceptions. Med J Aust 2016; 204(8): 318.
| Crossref | Google Scholar | PubMed |
14 Willmott L, White B, Gallois C, et al. Reasons doctors provide futile treatment at the end of life: a qualitative study. J Med Ethics 2016; 42(8): 496-503 Epub 17 May 2016.
| Crossref | Google Scholar |
15 Palda VA, Bowman KW, McLean RF, et al. “Futile” care: do we provide it? Why? A semistructured, Canada-wide survey of intensive care unit doctors and nurses. J Crit Care 2005; 20(3): 207-13.
| Crossref | Google Scholar | PubMed |
16 Carter HE, Winch S, Barnett AG, et al. Incidence, duration and cost of futile treatment in end-of-life hospital admissions to three Australian public-sector tertiary hospitals: a retrospective multicentre cohort study. BMJ Open 2017; 7(10): e017661 PMCID: PMC5652539.
| Crossref | Google Scholar | PubMed |
17 Huynh TN, Kleerup E, Wiley JF, et al. The Frequency and Cost of Treatment Perceived to Be Futile in Critical Care. JAMA Internal Med 2013; 173(20): 1887-94.
| Crossref | Google Scholar |
18 Barlas S. Health Care Price Transparency Initiatives Are All the Rage: But Burgeoning Efforts Suffer from Myriad Shortcomings. P T 2018; 43(12): 744-68 PMCID: PMC6281149.
| Google Scholar | PubMed |
19 Popescu GH. Economic aspects influencing the rising costs of health care in the United States. Am J Med Research 2014; 9(1): 47-52.
| Google Scholar |
20 Peters MA, Tesar M. The snake oil charms of positive psychology. Ed Philos Theory 2020; 52(11): 1116-9.
| Crossref | Google Scholar |
21 Saarni SI, Gylling HA. Evidence based medicine guidelines: a solution to rationing or politics disguised as science? J Med Ethics 2004; 30: 171-5.
| Crossref | Google Scholar | PubMed |
22 Devereux JA, Cordato DJ, Beran RG. Treating stroke patients with a poor prognosis – What’s law got to do with it? Med Law 2016; 35(4): 593-604.
| Google Scholar |
23 Devereux JA, Cordato DJ, Beran RG. Legal imperatives in treating severe stroke. Int J Stroke 2016; 11(8): NP86.
| Crossref | Google Scholar | PubMed |
24 Beran RG, Devereux JA. Reconciling medical and legal conceptions of surgery – an exercise in futility? Tort Law Review 2014; 22(2): 68-74.
| Google Scholar |
