Medical Futility: Has Ending Life Support Become the Next Pro-Choice/Right to Life Debate

This note will provide an analysis of the issue of medical futility and propose solutions to the issue. Part II considers the definition of medical futility and different ways to view the concept. In Part III, the position is forwarded that medical futility is a question of values which the medical profession is not necessarily more qualified than a layperson to answer. In Part IV, medical futility will be examined in the context of existing law. This section also addresses the potential tort liability of a health care provider who unilaterally takes certain actions based on the concept of medical futility, as well as the potential constitutional challenges that may be advanced by a patient or her family. This section also suggests that the courts should recognize a common law right to self-determination which would permit patients to continue on life support. Finally, Part V presents solutions to the conundrum of medical futility. Because of the intricate emotional and value laden issues surrounding medical futility, it is concluded that the issue of medical futility can best be addressed and resolved by communication between all the parties involved. Consequently, each solution is focused on requiring open communication from the parties. If the medical community is unable or unwilling to establish procedures for communication regarding medical futility, the legislature should establish procedures for handling medical futility confrontations. This note recommends a statutory framework to provide the best legislative solution to the issue

Stopping clinical trials early for futility: retrospective analysis of several randomised clinical studies

Background: Many clinical trials show no overall benefit. We examined futility analyses applied to trials with different effect sizes. Methods: Ten randomised cancer trials were retrospectively analysed; target sample size reached in all. The hazard ratio indicated no overall benefit (n=5), or moderate (n=4) or large (n=1) treatment effects. Futility analyses were applied after 25, 50 and 75% of events were observed, or patients were recruited. Outcomes were conditional power (CP), and time and cost savings. Results: Futility analyses could stop some trials with no benefit, but not all. After observing 50% of the target number of events, 3 out of 5 trials with no benefit could be stopped early (low CPless than or equal to15%). Trial duration for two studies could be reduced by 4–24 months, saving £44 000–231 000, but the third had already stopped recruiting, hence no savings were made. However, of concern was that 2 of the 4 trials with moderate treatment effects could be stopped early at some point, although they eventually showed worthwhile benefits. Conclusions: Careful application of futility can lead to future patients in a trial not being given an ineffective treatment, and should therefore be used more often. A secondary consideration is that it could shorten trial duration and reduce costs. However, studies with modest treatment effects could be inappropriately stopped early. Unless there is very good evidence for futility, it is often best to continue to the planned end

The Ethics of Futility Across the Age Continuum

Much has been written on the topic of medical futility with reports of its existence dating back to the time of Hippocrates. However, the majority of the research on the topic has been on the adult population. Very little literature addresses the presence of medically futile treatment across the age continuum identifying issues that impact neonates, pediatrics, as well as adults. This dissertation addresses the gap in the literature by considering the ethical problem of medical futility across the age continuum. By addressing the common thread of futility, there is an imperative for a call to action that encompasses the span of organizational ethics. This span not only includes the clinical and professional ethics, but also the business ethics. A broad review of the literature on both medical futility and moral distress was accomplished. This yielded an integrative approach to the ethics of medical futility at the end-of-life across the age continuum as well as its effect on the moral distress of the nurses caring for these patients. Findings indicate that medical futility, or inappropriate medical treatments at the end-of-life, are to be found in all critical care units across the age continuum. Although there are commonalities, each age group contends with ethical dilemmas surrounding the ethics of inappropriate medical treatments that are specific to their age group. The inappropriate medical treatments are not only the number one cause of moral distress in nurses, but also create moral distress for physicians and other allied health professionals. Increasing the conversation across the age continuum, that begins in nursing and medical schools, is needed to increase the awareness of medical futility and develop strategies to confront it. Improving communication, plus the use of advance directives and palliative care for all age groups, holds the greatest hope for the future in minimizing futile treatments at the end-of-life

The History of the Name \u3ci\u3ePanorpa\u3c/i\u3e Linnaeus (Mecoptera)

(excerpt) Attempts to understand the origin of Linnaeus\u27 name for the scorpionfly Panorpa have come to nought for a very good reason. The word does not mean anything at all. It is an interesting example of the futility of looking up names in a Latin or Greek dictionary to find their meaning when the history of the word is at all complicated. The word Panorpa is born of a series of taxonomic, philological, grammatical, and (perhaps) typographical errors which can be sorted out by a survey of the pre-Linnaean history of the word and of the insect. In order to keep the end in view throughout the argument that follows, the reader may be gratified to anticipate the conclusion that Panorpa comes ultimately from the Greek word parnops (genitive parnopos) meaning \u27locust.\u2

On the Brownian gas: a field theory with a Poissonian ground state

As a first step towards a successful field theory of Brownian particles in interaction, we study exactly the non-interacting case, its combinatorics and its non-linear time-reversal symmetry. Even though the particles do not interact, the field theory contains an interaction term: the vertex is the hallmark of the original particle nature of the gas and it enforces the constraint of a strictly positive density field, as opposed to a Gaussian free field. We compute exactly all the n-point density correlation functions, determine non-perturbatively the Poissonian nature of the ground state and emphasize the futility of any coarse-graining assumption for the derivation of the field theory. We finally verify explicitly, on the n-point functions, the fluctuation-dissipation theorem implied by the time-reversal symmetry of the action.Comment: 31 page

When can Muslims withdraw or withhold life support? A narrative review of Islamic juridical rulings.

When it is ethically justifiable to stop medical treatment? For many Muslim patients, families, and clinicians this ethical question remains a challenging one as Islamic ethico-legal guidance on such matters remains scattered and difficult to interpret. In light of this gap, we conducted a systematic literature review to aggregate rulings from Islamic jurists and juridical councils on whether, and when, it is permitted to withdraw and/or withhold life-sustaining care. A total of 16 fatwās were found, 8 of which were single-author rulings, and 8 represented the collective view of a juridical council. The fatwās are similar in that nearly all judge that Islamic law, provided certain conditions are met, permits abstaining from life-sustaining treatment. Notably, the justifying conditions appear to rely on physician assessment of the clinical prognosis. The fatwās differ when it comes to what conditions justify withdrawing or withholding life- sustaining care. Our analyses suggest that while notions of futility greatly impact the bioethical discourse regarding with holding and/or withdrawal of treatment, the conceptualization of futility lacks nuance. Therefore, clinicians, Islamic jurists, and bioethicists need to come together in order to unify a conception of medical futility and relate it to the ethics of withholding and/or withdrawal of treatment

Defining Medical Futility and Improving Medical Care

It probably should not be surprising, in this time of soaring medical costs and proliferating technology, that an intense debate has arisen over the concept of medical futility. Should doctors be doing all the things they are doing? In particular, should they be attempting treatments that have little likelihood of achieving the goals of medicine? What are the goals of medicine? Can we agree when medical treatment fails to achieve such goals? What should the physician do and not do under such circumstances? Exploring these issues has forced us to revisit the doctor-patient relationship and the relationship of the medical profession to society in a most fundamental way. Medical futility has both a quantitative and qualitative component. I maintain that medical futility is the unacceptable likelihood of achieving an effect that the patient has the capacity to appreciate as a benefit. Both emphasized terms are important. A patient is neither a collection of organs nor merely an individual with desires. Rather, a patient (from the word “to suffer”) is a person who seeks the healing (meaning “to make whole”) powers of the physician. The relationship between the two is central to the healing process and the goals of medicine. Medicine today has the capacity to achieve a multitude of effects, raising and lowering blood pressure, speeding, slowing, and even removing and replacing the heart, to name but a minuscule few. But none of these effects is a benefit unless the patient has at the very least the capacity to appreciate it. Sadly, in the futility debate wherein some critics have failed or refused to define medical futility an important area of medicine has in large part been neglected, not only in treatment decisions at the bedside, but in public discussions—comfort care—the physician’s obligation to alleviate suffering, enhance well being and support the dignity of the patient in the last few days of life

Involuntary Passive Euthanasia in U.S. Courts: Reassessing the Judicial Treatment of Medical Futility Cases

Over the past twenty-five years, a significant number of surrogate decision makers have demanded that a health care provider use medical technology to prolong a patient\u27s life beyond the point thought medically appropriate. These surrogates want to continue life-sustaining medical treatment (LSMT) that providers want to stop. While most of these futility disputes are resolved informally inside the hospital, dozens have now been litigated in U.S. courts. Because the judicial treatment of these disputes casts a long, dark shadow on the informal resolution of all the others, it is important to ascertain exactly what guidance these court cases provide. In assessing the judicial treatment of futility cases, most of the medical, legal, and bioethical literature concludes that courts have generally disfavored providers. But these assessments are based on limited and outdated sets of cases. In this article I offer a comprehensive review of futility cases from 1983 to 2007. Based on this review, I argue that courts have generally neither prohibited nor punished the unilateral refusal of LSMT. Providers have regularly obtained both ex ante permission and ex post forgiveness for stopping LSMT without consent

Do-not-resuscitate orders Ethical aspects on decision making and communication among physicians, nurses, patients and relatives

The purpose was to describe ethical aspects on how do-not-resuscitate (DNR) deci-sions are made, established, and communicated between physicians, nurses, patients and relatives. A random sample of 220 physicians and nurses answered a questionnaire about their attitudes to and experiences of the making and communication of a DNR decision. The re-sponse rate was 73%. Twenty seriously ill patients, and 21 relatives of patients who died with a DNR order, were interviewed. The literature on medical futility was searched for conditions for futility and moral consequences. The results showed that many physicians and nurses are uncertain about the rules and ethics of DNR orders. There are discrepancies between guidelines and attitudes regarding DNR orders, as well as between attitudes and behaviour. Seriously ill patients estimate open and straightforward conversations about treatments in the end of life. Relatives seem to get acceptable information and counselling. Conditions and consequences of medical futility may be approached in a new clinical way. There are numerous possible ethical conflicts within and between the principles of autonomy, non-maleficence, beneficence, and the virtues and ideals of the profession. Start a dialogue about end-of-life support with chronically ill and elderly patients, and their relatives, while they still are capable of understanding and authorisation. The clinical conversation model may make it easier. All involved should understand why certain deci-sions are made. Conditions and consequences of futility should be ascertained together with the patients, the relatives and the staff, after which a joint decision can be reached

The Crisis of Secularism: How Democracy Fuels Moral Panics and Religious Fundamentalism

While identifying humanity’s most cherished ideals, there is one notion that ultimately supplants all others: the notion of freedom. The concept itself and its encompassing rhetoric have been utilized ad nauseam by virtually all contemporary social orders to validate the levels of civilizational maturity and, perhaps more importantly, to set goals to which the same should strive. However, irrespective of its categorical position at the very summit of conscious human existence, its interpretational elasticity allows for a diminishing number of concessions. This paper offers critique and examines interactions between multiculturalism, cultural relativism, religion, and secularism within contemporary Western societies. It utilizes historical examples of overt and latent free speech and human rights violations to demonstrate futility and incompatibility of the conventional and fundamentalist religious ideologies with the concepts of egalitarianism and secularism. The Abrahamic religion of Islam serves as a centerpiece example of instances discussed. The paper further describes and employs sociologist Stanley Cohen’s concept of moral panic in an attempt to anatomize the problem and the reactions stemming from it. The conclusion reiterates exigency of the matter and offers a glimpse into the perplexity, danger, and evolution of the soi-disant progressive Western democracies in relation to palpable prosperity of the human enterprise. Research materials comprise various internet-based and traditional print sources