When is further medical treatment futile?

It's one of the toughest questions patients and their loved
ones can discuss with physicians: When is further medical treatment futile? The
conversation can become even more difficult if patients or their families
disagree with health care providers' recommendations on end-of-life care. Early,
clear communication between patients and their care teams, choosing health care
agent (Surrogate) to represent patients, by signing a Medical Power of Attorney
and Living Will, can help avoid conflicts.

"Health care professionals in the United States have
struggled with the importance of maintaining patient autonomy while attempting
to practice under the guidance of treatments based on beneficial care," states
Dr. Burkle, in the Mayo Clinic Proceedings.

Tips from Drs. Burkle and Benson to effectively discuss
end-of-life care include:

  • Clear
    communication: Early and clear communication between health care providers
    and patients or their surrogates is the best way to avoid disagreement
    over whether medical care should continue. Recent studies show that more
    than 95 percent of such disputes are resolved through mediated meetings
    involving physicians and patients/surrogates.
  • Choose
    objective surrogates if patients cannot represent themselves: The
    surrogate's role is to stand in the shoes of the patient and suppress his
    or her own judgment in favor of what the patient would have done. However,
    it is important to acknowledge that medical surrogates often struggle to
    balance their wishes for the patient with the patient's own wishes.
    Studies have found that not only do many surrogates fail to accurately
    predict a patient's treatment wishes, but when asked to resolve disputes,
    they are more likely to show bias by overestimating the patient's desire
    for continued treatment.
  • Involve
    third parties when necessary: When health care providers and patients or
    their advocates cannot agree on end-of-life care, involving a third party
    becomes necessary. Beginning in 1992, the Joint Commission, the largest
    hospital accreditation organization in the United States, required
    hospitals to establish procedures for considering ethical issues.
    Hospital-based ethics committees have been the most common response to
    this requirement.
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