Almost all of the major professional association guidelines on medical futility are more than a decade old. Finally, a new multi-society policy was published online yesterday. I was pleased to be a part of it.
There is controversy about how to manage requests by patients or surrogates for treatments that clinicians believe should not be administered. This multi-society statement provides recommendations to prevent and manage intractable disagreements about the use of such treatments in intensive care units.
The recommendations were developed using an iterative consensus process, including expert committee development and peer review by designated committees of each of the participating professional societies (American Thoracic Society, American Association for Critical Care Nurses, American College of Chest Physicians, European Society for Intensive Care Medicine, and Society of Critical Care).
The committee recommends:
- Institutions should implement strategies to prevent intractable treatment conflicts, including proactive communication and early involvement of expert consultants.
- The term “potentially inappropriate” should be used, rather than futile, to describe treatments that have at least some chance of accomplishing the effect sought by the patient, but clinicians believe that competing ethical considerations justify not providing them.
- Clinicians should explain and advocate for the treatment plan they believe is appropriate.
- Conflicts regarding potentially inappropriate treatments that remain intractable despite intensive communication and negotiation should be managed by a fair process of conflict resolution; this process should include hospital review, attempts to find a willing provider at another institution, and opportunity for external review of decisions.
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