Futile Care Policy for Hospitals

¶ … Futile Care Policy for Hospitals Futile care is that medical care given at such a time when the administration of such care has very little degree of good outcome; resuscitation efforts are not expected to improve or ameliorate the situation. Essentially there is no cause to administer treatment, due to the belief that the incapacitating condition cannot be improved. There are varying views on the issue of futile resuscitation, which fall within the general rubric of 'futile care'.

This report will address the topic of futile care through the framework of ethics and the development of a futile care policy for hospitals different than what currently exists. First a discussion is given on the concept of futile care, including those types of care that often fall into the 'futile' category in medical crisis situations, such as futile resuscitation. A discourse follows on differing views of administering futile care efforts.

A model is put forth toward developing a medically ethical systematic approach for determining when medical intervention may be considered 'futile'. A conclusion is offered to guide a hospital development plan for a futile care policy, and to highlight the main points of the paper. Conceptualization of Futile Care At times the terminology that is used to capture an ethically, legally, and emotionally charged issue can be off-putting.

To allow for full ideation of the concept of futile care in emergency medicine and palliative care, an examination on the topic of the term 'futile' is required. To be considered 'futile', an effort must have a low likelihood of success. In medicine, the semantics that are used to address clinical applications of medical care tend to be rather sterile. Generally speaking and lacking fine divinations, 'futile care' is that medical care that has a low likelihood of securing a good/favorable/successful outcome (Lachman, 2009).

The application of futile care, though it is considered 'futile', may be thought of in different ways. Some may call it a waste of resources. Others may see it as going against the best interests of the patient and patient's family. Some might say it is against Divine Will and a violation of the natural course of life (Marco, Larkin, Moskop, & Derse, 2000). Futile Care Efforts: Prescriptive Models of Decision-Making Hospitals must make protocols on how to address futile care cases.

Futile care issues in medicine are an ethically challenging area of discourse. How the healthcare professional handles these situations is dependent upon their environment (laws, policies, and statutes), their principles (Hippocratic Oath), the family and patient in question, and the outcome of the futile care efforts. Jonson, Seigler, and Winslade (2002) developed a medical model for healthcare professionals in applying futile care efforts which looked at four areas, and is given thusly: Medical Indications Quality of Life Patient Preferences Contextual Features (Jonson, Seigler, & Winslade, 2002).

The Psychological Component: The Patient and Family Medical indications refer to what is happening with the patient, what their current crisis is. Patient preferences is what does the patient wish to happen; that is, do they have an Advanced Directive in place in these situations, and what does it relate. Quality of life relates to the goal of medical intervention to improve, restore or maintain the quality of life of the patient.

Contextual preferences are those other factors such as social setting, finances, home life, and other issues that must be taken into account in the decision to administer futile care. The hospital should always defer to the patient and family that has an advanced directive in place, and if the patient cannot speak for themselves but has an advanced directive, then a proxy must make the decision.

The only case where the hospital should be allowed to make the decision on futile care is in the absence of a proxy, in the absence of an advanced directive, and only if it is in the best interest of the patient. In this psychological-based model, the healthcare professional and hospital is put in the position of negotiating with the family and/or patient.

Burns and Truog (2007) state that in these situations the healthcare professional should always follow the wishes of the patient's family in futile care efforts (Burns & Truog, 2007). However, that view places a burden on the healthcare professional to compromise medical principles when that professional deems the care to be inappropriate and ultimately unnecessary (Forde, 1998). In brief, there may be situations that are very clearly defined as situations where futile care is not warranted; in other situations the issue may not be so easy to determine and requires more objective clarification.

Marsden (1995) examined data from a six-year time period of cardiac arrests for the Scottish Ambulance Service. The finding was that those patients with a non-shockable rhythm never survived resuscitation attempts. The results of the Marsden study led to the development of guidelines for ambulance personnel in Scotland given in the form of a quick algorithm that could be used on scene (Marsden, Ng, Dalziel, & Cobbe, 1995). Conclusion The hospital, in designing a futile care policy, must adhere to state ethical standards and state laws.

In the State of Massachusetts, for example, it is punishable by law for any medical professional to ignore the dictates of an advanced directive (Massachusetts Office of Health and Human Services, 2011). Therefore it is.