Mass General - Futility Policy Experience

Andrew Courtwright and colleagues at the Massachusetts General Hospital have published "Experience with a hospital policy on not offering cardiopulmonary resuscitation when believed more harmful than beneficial" in the Journal of Critical Care.



This was a retrospective cohort study of all ethics committee consultations between 2007 and 2013 with the MGH "not offering CPR policy."  There were 134 cases of disagreement over whether to provide CPR. 

• In 45 cases (33.6%), the patient or surrogate agreed to a do-not-resuscitate (DNR) order after initial ethics consultation. 


• In 67 (75.3%) of the remaining 89 cases, the ethics committee recommended not offering CPR. 


• In the other 22 (24.7%) cases, the ethics committee recommended offering CPR. 

While incidental to the focus of the study, it surprised me that in 7.5% of the conflict cases the patient herself made the request for CPR.  In contrast, in other reported studies of futility disputes, the patient almost always lacks capacity and the LST decision is made by a surrogate.



It is also worth noting that these numbers indicate a high prevalence of futility disputes.

• These 134 cases are just those that reached Optimum Care Committee consultation.


• 134 cases over 7 years means about 2 futility conflicts per month.


• These are just the futility conflicts pertaining to CPR.  Presumably there are many more concerning vents, CANH, and other interventions.