What does “futility” mean? An empirical study of doctors’ perceptions
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02/05/2016
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Resumo |
Objective(s) To describe how doctors define and use the terms “futility” and “futile treatment” in end-of-life care. Design, Setting, Participants A qualitative study using semi-structured interviews with 96 doctors across a range of specialties who treat adults at the end of life. Doctors were recruited from three large Australian teaching hospitals and were interviewed from May to July 2013. Results Doctors’ conceptions of futility focused on the quality and chance of patient benefit. Aspects of benefit included physiological effect, weighing benefits and burdens, and quantity and quality of life. Quality and length of life were linked, but many doctors discussed instances when benefit was determined by quality of life alone. Most doctors described the assessment of chance of success in achieving patient benefit as a subjective exercise. Despite a broad conceptual consensus about what futility means, doctors noted variability in how the concept was applied in clinical decision-making. Over half the doctors also identified treatment that is futile but nevertheless justified, such as short-term treatment as part of supporting the family of a dying person. Conclusions There is an overwhelming preference for a qualitative approach to assessing futility, which brings with it variation in clinical decision-making. “Patient benefit” is at the heart of doctors’ definitions of futility. Determining patient benefit requires discussions with patients and families about their values and goals as well as the burdens and benefits of further treatment. |
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application/pdf |
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Australasian Medical Publishing Company Ltd |
Relação |
http://eprints.qut.edu.au/95491/3/95491.pdf DOI:10.5694/mja15.01103 White, Benjamin P., Willmott, Lindy, Close, Eliana, Shepherd, Nicole, Gallois, Cindy, Parker, Malcolm, Winch, Sarah, Graves, Nicholas, & Callaway, Leonie (2016) What does “futility” mean? An empirical study of doctors’ perceptions. Medical Journal of Australia, 204(8), 318.e1-318.e5. http://purl.org/au-research/grants/ARC/LP120100096 |
Direitos |
Copyright 2016 Australasian Medical Publishing Company Ltd |
Fonte |
Faculty of Health; Faculty of Law; Australian Centre for Health Law Research; Institute of Health and Biomedical Innovation; School of Law; School of Public Health & Social Work |
Palavras-Chave | #220101 Bioethics (human and animal) #220106 Medical Ethics #Futile treatment #Futility #End of life decision-making #Withholding and withdrawing life-sustaining treatment #Doctors' perceptions |
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Journal Article |