Objectives

1. Describe the three main deinitions of “medical futility.”

2. Identify the key factors at the heart of disagreements between surrogates andproviders concerning whether a treatment is beneicial.

3. Distinguish six strategies that ethics committees can use to prevent and to resolvemedical futility disputes.

Case

One year ago, 73-year-old Mr. B came to your hospital for surgery on a thymus gland tumor.While the surgery was successful, during his post-operative recovery, Mr. B’s endotracheal tubebecame dislodged. This resulted in severe, irreversible brain damage. Mr. B was subsequentlydischarged to other facilities. But, 6 months ago, he was readmitted to your hospital with adiagnosis of renal failure. He has remained there ever since, in a persistent vegetative state,dependent for survival on mechanical ventilation, hemodialysis, and tube feedings. Mr. B hasdeveloped increasingly severe decubitus ulcers and recurrent infections. He remains a full code.

In light of his deteriorating status, Mr. B’s physicians have determined that he is beyond medicalrescue. They think that it is medically inappropriate and outside the standard of care to continuehis life-sustaining treatment. Indeed, they think it is ethically inappropriate and inhumaneto sustain Mr. B artificially while his body is decomposing.

The treatment team wants to discontinue dialysis and issue a DNAR order. They have carefullyexplained their proposed treatment plan to Mr. B’s surrogate, his daughter. But, even aftermany conferences, she will not consent. Mr. B’s family is very close. Discussion with his wife andsons confirms that the surrogate is acting in accordance with Mr. B’s consistent, considered, anddeliberated preferences. The hospital tried to transfer Mr. B to another facility willing to providethe disputed treatment, but none could be found. Mr. B’s attending physician has sought guidancefrom the ethics committee.