The Appropriate Use of Increasingly Sophisticated Life-Sustaining Technology

Darryl Abrams and colleagues at Columbia University have a great new article on medical futility in the December 2013 AMA Virtual Mentor.



They write:  "There seems to be a general, if unofficial, consensus among most intensivists that surrogate requests . . . be granted even when patients are irreversibly ill and will not survive . . . ."  The authors observe:  "Up to now, patients and families in the U.S. have been given considerable leeway in having requests for such technology granted, even against medical advice.  Our society has been generous in this regard . . . ." 



"Criteria for stopping these sophisticated treatments when therapeutic goals can no longer be met are currently not well defined. . . .  there is no societal consensus about who should have the last word when patients or their families and physicians disagree about the appropriateness of using sophisticated medical technology in situations where such treatment clearly serves only to prolong the dying process."



Still, Abrams and colleagues note that there are some limits to this "liberal policy."  They observe that "a line is drawn . . . at more sophisticated and resource-intensive technologies such as ECMO . . . ."  But they fear that line may shift unless the medical community should starts to "formulate guidelines that delineate the appropriate use of organ-replacement therapies."