Futile Care Policy Development: Ethics in Hospitals
This paper examines the concept of futile care in hospital and emergency medicine settings, with a focus on developing an ethically grounded hospital policy. It defines futile care as medical treatment with a low likelihood of producing a favorable outcome, and surveys differing perspectives on its administration. Drawing on prescriptive models—including the four-factor framework proposed by Jonson, Seigler, and Winslade—the paper explores how medical indications, patient preferences, quality of life, and contextual factors inform decision-making. It also addresses the psychological dimensions affecting patients and families, the role of advanced directives, and the legal obligations of healthcare institutions. A concluding policy recommendation emphasizes bioethics oversight and adherence to state law.
- Introduction: Defines futile care and outlines paper scope
- Conceptualization of Futile Care: Examines meaning and perspectives on futility
- Futile Care Efforts: Prescriptive Models of Decision-Making: Introduces four-factor clinical decision framework
- The Psychological Component: The Patient and Family: Explores family, proxy, and advanced directive roles
- Conclusion: Policy recommendations and bioethics oversight guidance
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What makes this paper effective
- Clearly defines the central concept of futile care before moving into policy and ethical analysis, grounding the reader in terminology before introducing complexity.
- Integrates a recognized clinical framework (Jonson, Seigler, and Winslade's four-factor model) to structure the ethical discussion, lending academic credibility to the policy recommendations.
- Balances abstract ethical reasoning with a concrete empirical example—the Marsden study on cardiac arrests—demonstrating how data can inform clinical guidelines.
Key academic technique demonstrated
The paper demonstrates applied ethical reasoning: it does not merely describe competing viewpoints but uses them to build toward a practical policy recommendation. By acknowledging multiple stakeholder perspectives (patient, family, healthcare professional, and institution) and then resolving tension through a framework, the author shows how ethical analysis can produce actionable guidelines.
Structure breakdown
The paper follows a logical five-part structure: a framing introduction, a conceptual definition section, a model-based analysis of decision-making processes, a deeper exploration of the psychological and legal dimensions, and a conclusion with direct policy guidance. Each section builds on the last, moving from abstract definition to practical recommendation in a clear progression.
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.
References
Burns, J., & Truog, R. (2007). Futility: A concept in evolution. Chest, 1987–1993.
Forde, R. (1998). Who is to define the futility of treatment—the patient or the physician? Tidsskr nor Laegeforen (Norwegian), 2652–2654.
Jonson, A., Seigler, M., & Winslade, W. (2002). Clinical Ethics (5th ed.). New York, NY: McGraw-Hill.
Lachman, V. (2009). Ethical Challenges in Health Care: Developing Your Moral Compass. New York, NY: Springer Publishing.
Marco, C., Larkin, G., Moskop, J., & Derse, A. (2000). Determination of "futility" in emergency medicine. Annals of Emergency Medicine, 604–612.
Marsden, A., Ng, G., Dalziel, K., & Cobbe, S. (1995). When is it futile for ambulance personnel to initiate cardiopulmonary resuscitation? British Medical Journal, 49–51.
Massachusetts Office of Health and Human Services. (2011). Decision-making guidelines. Retrieved January 18, 2011, from Massachusetts Office of Health and Human Services: http://www.mass.gov/?pageID=eohhs2terminal&L=6&L0=Home&L1=Provider&L2
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