International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Futile, non-beneficial, potentially inappropriate or ‘disputed’ treatment

This chapter examines the concept of futility in end-of-life decision-making. The term is generally used to describe the situation where the clinical treating team consider potentially life-sustaining treatment should not be provided. But the term ‘futility’ is a vexed one. Alternative terminology has been proposed such as ‘non-beneficial’ or ‘potentially inappropriate’ treatment. We contribute to these debates by offering another term – ‘disputed treatment’ – albeit one more limited in its application to where there is a disagreement about treatment. The chapter then traces key debates in the literature including attempts to define the term futility conceptually, and later empirically. A more recent body of work has also proposed a procedural approach to resolving futility disputes. Unsurprisingly, given the subjectivity of this concept, all of these approaches have been critiqued and these objections are considered. The chapter also considers the value of a concept like futility and its relationship with the distinct issue of health rationing. A final contribution is to offer an alternative approach to disputes about treatment that challenges the idea that futility decisions are ones for doctors, but also constrains the power of patients and substitute decision-makers to demand treatment