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New Hastings Center Guidelines on Medical Futility

Posted Jun 13 2013 4:48pm
The new Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life do not have very much useful guidance on medical futility disputes.

Page 14 provides:  The right to refuse treatment does not establish a right to demand any and all treatment a patient or surrogate chooses.  The goal of respect for persons should not be reduced to "do whatever the patient wants" or "do whatever the surrogate thinks the patient would have wanted."

But any details on this proposition focus only on 
  • "the misuse of resources that have no prospect of benefiting a patient." (page 16)  
  • "treatment burdens without possibility of benefit" (page 57)
  • "treatment that cannot provide physiological benefit" (page 57)

Those truly "futile" situations are the extremely rare "easy" cases.  Where are the Guidelines on the hard cases that actually arise in ICUs?

On the other hand, the Guidelines do usefully recommend "time-limited trials" (page 55).  They recommend avoiding the phrase "doing everything" (page 56).  And they contain many other good tips on communication and establishing/reviewing goals of care that should help avoid conflict.

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