Futile Care Policy Development: Ethics in Hospitals

Introduction

Futile care is medical care administered at a point when there is very little likelihood of a good outcome; resuscitation efforts are not expected to improve or ameliorate the patient's condition. Essentially, there is no compelling reason to administer treatment when it is believed that an 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 paper addresses the topic of futile care through the framework of bioethics and the development of a futile care policy for hospitals. First, the concept of futile care is discussed, 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 regarding the administration of futile care efforts. A model is then put forth toward developing a medically ethical, systematic approach for determining when medical intervention may be considered futile. Finally, a conclusion is offered to guide a hospital development plan for a futile care policy and to highlight the paper's main points.

Conceptualization of Futile Care

At times, the terminology used to capture an ethically, legally, and emotionally charged issue can be off-putting. To allow for full consideration of the concept of futile care in emergency medicine and palliative care, an examination of the term "futile" itself is required. To be considered futile, an effort must have a low likelihood of success.

In medicine, the language used to address clinical applications of care tends to be precise and clinical. Generally speaking, futile care is medical care that has a low likelihood of securing a favorable or successful outcome (Lachman, 2009). The application of futile care, though considered futile, may be understood in different ways. Some view it as a waste of resources. Others see it as working against the best interests of the patient and the patient's family. Some argue it violates Divine Will and the natural course of life (Marco, Larkin, Moskop, & Derse, 2000).

Futile Care Efforts: Prescriptive Models of Decision-Making

Hospitals must develop protocols for addressing futile care cases. Futile care issues in medicine represent an ethically challenging area of practice. How healthcare professionals handle these situations depends upon their environment (laws, policies, and statutes), their professional principles (including the Hippocratic Oath), the specific family and patient involved, and the expected outcomes of the futile care efforts. Jonson, Seigler, and Winslade (2002) developed a clinical ethics model for healthcare professionals applying futile care efforts, organized around four key areas:

1. Medical Indications
2. Quality of Life
3. Patient Preferences
4. Contextual Features

(Jonson, Seigler, & Winslade, 2002).

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 the responsibility of the hospital to maintain a bioethics committee to oversee its healthcare professionals' compliance with state regulations and to ensure adherence to the wishes of the patient and family involved. There will clearly be gray areas in determining the right course of action in certain situations; however, having compliance guidelines—such as Advanced Directives, adherence to state laws, and recognition of patient autonomy and family rights—will ultimately guide the outcome in futile care cases.