Beyond Futility in Pediatrics: Alleviating Moral Distress for Family and Staff

A group of providers from Methodist Children's Hospital in San Antonio, Texas is presenting "Beyond Futility in Pediatrics: Alleviating Moral Distress for Family and Staff" at  NHPCO's 11th Clinical Team Conference in Atlanta in September 2010.  Here is the description

The term "medical futility" emerged in the 1980s to describe situations in which families demand medical treatment which caregivers deem inappropriate. These cases create significant moral distress for healthcare providers and families. This distress may be more pronounced in pediatrics due to the nature of childhood illness and the complexity of family dynamics. Previous efforts to resolve futility conflicts focused on defining futile treatment and deciding who has decision-making authority. When these efforts failed, many hospitals (and some state legislatures) adopted a procedural approach to conflict resolution. While this approach has merits, it fails to address the moral distress inherent in these conflicts. As a result, families may feel abandoned and caregivers burned out. In this workshop, we describe an interdisciplinary approach to resolving conflicts involving end-of-life care in pediatrics. This approach encourages effective communication early in the conflict and has enabled our institution to avoid implementation of state futility law.

I know that many Texas providers that do use the TADA mechanism also employ an interdisciplinary approach and also encourage effective communication early in the conflict.  But they still end up with some intractable conflict.  (Interestingly, even SSM's presentation "A More Effective Approach" for the Catholic Health Association yesterday admitted a residual rate of intractable conflict.) It is for those few remaining cases for which implementation of the law is most appropriate.  Of course, nothing stops a facility from moving directly to formal procedures.