
Contents
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Introduction Introduction
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History of the Futility Debate History of the Futility Debate
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Origins in Ancient Greece Origins in Ancient Greece
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Introduction of Life-Sustaining Treatment Introduction of Life-Sustaining Treatment
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Rise of Patient Autonomy Rise of Patient Autonomy
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From Negative Rights to Positive Rights From Negative Rights to Positive Rights
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Prevalence of Futility Disputes Prevalence of Futility Disputes
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Causes of Futility Disputes Causes of Futility Disputes
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Reasons Surrogates Request Nonrecommended Treatment Reasons Surrogates Request Nonrecommended Treatment
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Distrust Distrust
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Cognitive Issues Cognitive Issues
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Psychological and Emotional Issues Psychological and Emotional Issues
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Religion and Miracles Religion and Miracles
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Reasons Clinicians Resist Surrogate Requests Reasons Clinicians Resist Surrogate Requests
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Avoid Patient Suffering Avoid Patient Suffering
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Respect Patient Autonomy Respect Patient Autonomy
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Protect the Integrity of the Medical Profession Protect the Integrity of the Medical Profession
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Avoid Moral Distress Avoid Moral Distress
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Promote Good Stewardship Promote Good Stewardship
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Summary Summary
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Major Positions Major Positions
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Definitional Approach: Physiological Futility Definitional Approach: Physiological Futility
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Definitional Approach: Medical Ineffectiveness Definitional Approach: Medical Ineffectiveness
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Definitional Approach: Quantitative Futility Definitional Approach: Quantitative Futility
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Definitional Approach: Qualitative Futility Definitional Approach: Qualitative Futility
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Procedural Process-Based Approach Procedural Process-Based Approach
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Surrogate Selection Approach Surrogate Selection Approach
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Conscience-Based Objection Approach Conscience-Based Objection Approach
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Distributive Justice Approach Distributive Justice Approach
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Major Policy Statements Major Policy Statements
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American Thoracic Society (1991) American Thoracic Society (1991)
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Society of Critical Care Medicine (1997) Society of Critical Care Medicine (1997)
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American Medical Association (1999) American Medical Association (1999)
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Texas Advance Directives Act (1999) Texas Advance Directives Act (1999)
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General Medical Council (2010) General Medical Council (2010)
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American College of Physicians (2012) American College of Physicians (2012)
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ATS/AACN/ACCP/ESICM/SCCM (2015) ATS/AACN/ACCP/ESICM/SCCM (2015)
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How Clinicians Should Respond How Clinicians Should Respond
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Implement Preventative Strategies Implement Preventative Strategies
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Refuse Requests for Physiologically Futile, Proscribed, and Discretionary Treatments Refuse Requests for Physiologically Futile, Proscribed, and Discretionary Treatments
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Attempt Negotiated Agreement Attempt Negotiated Agreement
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Give Notice of the Process to Surrogates Give Notice of the Process to Surrogates
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Obtain a Second Medical Opinion Obtain a Second Medical Opinion
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Provide Review by an Interdisciplinary Hospital Committee Provide Review by an Interdisciplinary Hospital Committee
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Offer Surrogates the Opportunity for Transfer Offer Surrogates the Opportunity for Transfer
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Inform Surrogate of Their Opportunity to Pursue Extramural Appeal Inform Surrogate of Their Opportunity to Pursue Extramural Appeal
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Implement the Decision of the Resolution Process Implement the Decision of the Resolution Process
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Role of Judicial or Other Independent Review Role of Judicial or Other Independent Review
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Conclusion Conclusion
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References References
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5 Medical Futility and Potentially Inappropriate Treatment
Get accessDouglas White, MD, MAS, Associate Professor of Critical Care Medicine, University of Pittsburgh Medical Center, Department of Critical Care Medicine
Thaddeus Pope, JD, PhD, Director, Health Law Institute, Hamline University School of Law
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Published:10 September 2015
Cite
Abstract
This article provides a historical, ethical, and conceptual review of medical futility disputes in the intensive care unit (ICU). Particular emphasis is placed on the role that physician power plays in these disputes. Specifically, the article analyzes the circumstances and arguments proposed to justify when physicians may stop life-sustaining treatment without the consent of either the patient or surrogate. The article begins by reviewing the history of the medical futility movement and the causes of medical futility disputes. Second, the major positions and policy statements addressing how such disputes should be resolved are summarized. Third, the article turns from an objective, descriptive approach to a more normative approach by highlighting the value-laden nature of most “futility” judgments regarding potentially inappropriate treatment. Finally, an outline of how clinicians should respond to requests for ICU interventions that they deem medically or ethically inappropriate is provided.
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