Ethical Conflicts Between Patient and Physician Are Common in Futility Care

Clear communication between patients and caregivers with regard to treatment futility or the perception of treatment futility remains the cornerstone approach for mitigating “emotional fallout for surrogates” and reducing distress among emergency physicians, according to a paper recently published in the Annals of Emergency Medicine.

Investigators explored futility in emergency medicine, as well as the ethical aspects of denying treatment based on the perception of treatment futility. 

According to the researchers, previous literature described the word “futility” as seemingly ineffective medications or interventions that could be withheld from use despite the wishes of the patient and the patient’s family members.

In some circumstances, futility may be called on because of ethical concerns. The researchers note that some physicians “may invoke futility to unilaterally withhold treatment when the treatments ‘prolong the dying process’ ” at the bedside. 

For example, patients who may die the day after hospital admission may not receive additional therapies because of their inappropriateness and ultimate ineffectiveness. In addition, many physicians experience distress or remorse when withholding treatment and are considered to be at risk for burnout and “compassion fatigue.”

Critics of this term, as well as its associated actions in clinical practice, express that it reduces a patient’s autonomy as well as enforces physicians’ own authority “to unilaterally make decisions that properly belong to patients or their surrogates.”

Researchers of this review also note that even if the wishes of a patient or family member appear unreasonable, these cases should be evaluated with an ethics consultation to explore the potential benefits and ramifications associated with providing vs withholding treatment based on futility.

Simon JR, Kraus C, Rosenberg M, et al. “Futile care”-an emergency medicine approach: ethical and legal considerations [published online July 26, 2017]. Ann Emerg Med. doi: 10.1016/j.annemergmed.2017.06.005