TY - JOUR
T1 - Ethics seminars
T2 - Case studies in ‘futility’ - Challenges for academic emergency medicine
AU - Marco, Catherine A.
AU - Larkin, Gregory L.
PY - 2000
Y1 - 2000
N2 - The concept of 'futility' and its determination in emergency medicine pose unique challenges to emergency physicians, patients, and society. The term 'futility,' although commonly used, is problematic in its scope, meaning, and interpretation. To bridge this gap in understanding, the authors suggest the construct of clinically nonbeneficial interventions (CNBI), instead of 'futility.' This language better informs discussions of nonbeneficial interventions across the risk spectrum of emergency medical practice, while retaining the focus on the patient's interests. Two cases are presented, which underscore the need for prudence and empathetic communication when addressing issues of CNBI. Determinations of expected benefit should be based on established scientific evidence, and the goals and values of patients, not on individual biases regarding quality of life or other subjective matters. While physicians are under no ethical obligation to provide treatments that they judge have no realistic likelihood of clinical benefit, the context in which these determinations take place is of critical importance. When certain interventions are appropriately withheld, concerted efforts should be made to maintain effective communication, comfort, support, and counseling for patients, friends, and families. In all aspects of clinical decision making, the value of various interventions and therapies must be based on expected risks and benefits to the patients, first and foremost.
AB - The concept of 'futility' and its determination in emergency medicine pose unique challenges to emergency physicians, patients, and society. The term 'futility,' although commonly used, is problematic in its scope, meaning, and interpretation. To bridge this gap in understanding, the authors suggest the construct of clinically nonbeneficial interventions (CNBI), instead of 'futility.' This language better informs discussions of nonbeneficial interventions across the risk spectrum of emergency medical practice, while retaining the focus on the patient's interests. Two cases are presented, which underscore the need for prudence and empathetic communication when addressing issues of CNBI. Determinations of expected benefit should be based on established scientific evidence, and the goals and values of patients, not on individual biases regarding quality of life or other subjective matters. While physicians are under no ethical obligation to provide treatments that they judge have no realistic likelihood of clinical benefit, the context in which these determinations take place is of critical importance. When certain interventions are appropriately withheld, concerted efforts should be made to maintain effective communication, comfort, support, and counseling for patients, friends, and families. In all aspects of clinical decision making, the value of various interventions and therapies must be based on expected risks and benefits to the patients, first and foremost.
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U2 - 10.1111/j.1553-2712.2000.tb01266.x
DO - 10.1111/j.1553-2712.2000.tb01266.x
M3 - Article
C2 - 11015248
AN - SCOPUS:0033776956
SN - 1069-6563
VL - 7
SP - 1147
EP - 1151
JO - Academic Emergency Medicine
JF - Academic Emergency Medicine
IS - 10
ER -