Futility in the ICU: Prevention, Procedure, and Policy

If you are at CHEST 2013, I hope to see you at "Futility in the ICU: Prevention, Procedure, and Policy" on Wednesday, October 30, 2013, from 7:30 AM - 9:00 AM in W178b McCormick Place.  Here is a link to the schedule for session 10232.

• Ethical Principles at Stake in Futility Disputes -- Gabriel Bosslet


• Futility Legislation: Lessons From Texas -- Richard Castriotta


• Medicolegal Aspects to Futility in the ICU -- Thaddeus Pope


• Prevention of Futility Disputes in the ICU -- Dee Ford

Over the last 20 years, critical care has witnessed substantial change in ethical thought on limitations to aggressive care. Initially the notion that limitations could be placed on life-sustaining treatments was rejected based on the principle of life as a paramount value. Eventually patients won the freedom to decline undesired treatments in landmark court cases on the basis of patient autonomy. 



Today the majority of ICU deaths are preceded by withholding or withdrawing some aspect if intensive care. In contrast to previous decades, the ethical challenges ICU clinicians struggle with currently center around cases when ongoing critical care has been deemed unlikely to provide substantial or enduring clinical benefit to the patient, but the patient or their surrogate desires to continue aggressive care. Thus, the issue of medical futility has generated much discourse and explicit policies and procedures to cope with perceived futility and conflicts around goals of care.