What does “futility” mean? An empirical study of doctors’ perceptions

Med J Aust 2016; 204 (8): 318.
Authors: Ben White, Lindy Willmott, Eliana Close, Nicole Shepherd, Cindy Gallois, Malcolm H Parker, Sarah Winch, Nicholas Graves and Leonie K Callaway
Objective: To investigate how doctors define and use the terms “futility” and “futile treatment” in end-of-life care. Design, setting, participants: A qualitative study using semi-structured interviews with 96 doctors from a range of specialties which treat adults at the end of life. Doctors were recruited from three large Brisbane teaching hospitals and were interviewed between May and July 2013.”
Find article here.  Find related editorial ‘Futility and utility’ here.

Medical Board of Australia v Siow [2016] SAHPT 1

Decision 22 January 2016, last updated 1 February 2016
“CATCHWORDS: Complainant alleges that the respondent behaved in a way that constitutes professional misconduct – Complaint alleged ten grounds of professional misconduct – Respondent admits professional misconduct in respect of each of the grounds set out in the complaint – The respondent consulted with a patient who had been diagnosed with a terminal illness – Despite an awareness of the patient’s terminal illness and prognosis the respondent devised a nutritional and detoxification program and referred the patient to other medical practitioners – The respondent so conducted himself and made statements to the patient and his family members that continued to engender an unreasonable expectation on their part as to a positive outcome for the patient contrary to the prognosis – Held: The conduct set out in the complaint constitutes professional misconduct – The Tribunal is satisfied that appropriate public protection and discipline are achieved by: A reprimand – Payment of a fine of $12,000 – Conditions imposed on the respondent’s registration”
Find decision here.

Medically Inappropriate or Futile Treatment: Deliberation and Justification

J Med Philos (2015) doi: 10.1093/jmp/jhv035
Authors: Cheryl J. Misak, Douglas B. White and Robert D. Truog
“This paper reframes the futility debate, moving away from the question “Who decides when to end what is considered to be a medically inappropriate or futile treatment?” and toward the question “How can society make policy that will best account for the multitude of values and conflicts involved in such decision-making?””
Find abstract here.

Laying Futility to Rest

J Med Philos 2015 40: 554-583
Author: Michael Nair-Collins
“I argue that the concept of futility does not justify unilateral decisions to forego life-sustaining medical treatment over patient or legitimate surrogate objection, even when futility is determined by a process or subject to ethics committee review. Furthermore, I argue for a limited positive ethical obligation on the part of health care professionals to assist patients in achieving certain restricted goals, including the preservation of life, even in circumstances in which most would agree that that life is of no benefit to the patient.”
Find article here.

The Texas Advanced Directive Law: Unfinished Business

The American Journal of Bioethics, Volume 15, Issue 8, 2015
Authors: Michael Kapottos & Stuart Youngner
“The Texas Advance Directive Act allows physicians and hospitals to overrule patient or family requests for futile care. Purposefully not defining futility, the law leaves its determination in specific cases to an institutional process. While the law has received several criticisms, it does seem to work constructively in the cases that come to the review process. We introduce a new criticism…”
Find abstract here and links to related commentary articles here.

When ethical reform became law: the constitutional concerns raised by recent legislation in Taiwan

J Med Ethics Published online 16 October 2013

Author: Yi-Chen Su

“…Ethics debates on medical issues seldom involve the constitution. Nonetheless, the constitution must be considered when advocates seek to enforce their views on medical ethics through state actions such as legislation. The medical community in Taiwan persuaded the government to remove the arguably burdensome legal procedure required for the termination of incompetent patients’ life-sustaining treatment based on futility and waste.2 However, the new law, as the embodiment of the medical community’s collective view, has raised constitutional concerns…”

Find article here.

Doctor accused of selling false hope to families

USA Today, By Liz Szabo, November 15, 2013

“Josia’s parents would have paid any price to save him.  A Texas doctor, two months, earlier, had given them one: $25,000 upfront, by cash or check.  Clinging to hope, the Linden, N.J., couple took Josia to see Stanislaw Burzynski, a Houston doctor claiming to be able to do what no one else can: cure inoperable pediatric brainstem tumours.  Virtually any other doctor might have recited the same sad statistics: Although doctors can now cure 83% of pediatric cancers in the U.S., there is usually no hope for kids with Josia’s tumor. Perhaps 5% survive five years.”

Find article here.

Doctors Keep Brain Dead Mother Alive For Months To Deliver Baby Read more: Doctors Keep Brain Dead Mother Alive For Months To Deliver Baby

Time, By Sophie Brown, Nov. 14, 2013

“Doctors in Hungary have delivered a healthy baby boy by caesarean after keeping his brain dead mother on life support for three months, AFP reported Wednesday. The 31-year-old woman was declared brain dead when she suffered a stroke in her 15th week of pregnancy earlier this year.  The mother also helped four other people gain a new lease on life, as some of her organs — her heart, liver, pancreas and kidneys — were able to be donated after the birth of the child. Doctors say the baby is healthy.”

Find article here.

Paralyzed Hunter Chooses to End Life Support

ABC News, By Jeni O’Malley, November 5, 2013

“Tim Bowers got to decide for himself whether he wanted to live or die. When the avid outdoorsman was badly hurt Saturday in a hunting accident, doctors said he would be paralyzed and could be on a ventilator for life. His family had a unique request: Could he be brought out of sedation to hear his prognosis and decide what he wanted to do? Doctors said yes, and Bowers chose to take no extra measures to stay alive. He died Sunday, hours after his breathing tube was removed. “We just asked him, ‘Do you want this?’ And he shook his head emphatically no,” his sister, Jenny Shultz, said of her brother, who was often found hunting, camping or helping his father on his northeastern Indiana farm. The 32-year-old was deer hunting when he fell 16 feet from a tree and suffered a severe spinal injury that paralyzed him from the shoulders down. Doctors thought he might never breathe on his own again. Courts have long upheld the rights of patients to refuse life support. But Bowers’ case was unusual because it’s often family members or surrogates, not the patient, who make end-of-life decisions. Medical ethicists say it’s rare for someone to decide on the spot to be removed from life support, especially so soon after an injury. But standard medical practice is to grant more autonomy to patients.”

Find article here.

Courts may not be able to rule on value of treatments when doctors and families clash

BMJ 2013;347:f6615 1 November 2013

Author: Clare Dyer

“A Court of Protection judge who refused to grant declarations that three types of treatment should be withheld from a seriously ill man with limited consciousness got the law right, the UK Supreme Court has ruled unanimously.1…

In its first case on the Mental Capacity Act 2005, the UK’s highest court laid down important guidance for doctors faced with family opposition to decisions to discontinue treatment on clinical grounds…

The doctors sought a court declaration that it would be in James’s best interests to withhold the treatments. But Jackson was not persuaded that the treatments would be futile or overly burdensome or that there was no prospect of recovery—in the sense of achieving a quality of life the patient would consider worth while. The judge also thought that the closeness of James’s family life had been undervalued in reaching the decision…”

Find article here.