The debate over how to define ‘futile’ treatment has hit the headlines again, with a new study showing doctors support the concept but more than half have difficulty coming to a consensus on how to approach it in a clinical setting.
The study, published in the MJA, found that while the term was widely employed, there was some confusion about its meaning and when to invoke it, with many doctors seeking colleagues’ opinions before making decisions.
“Futile medical treatment is a pressing challenge for Australian clinicians and the Australian health system,” the authors wrote. “Futile treatment can prevent a good death and may cause distress to patients and families, as well as moral distress to health professionals.
“Additionally, futile treatment consumes scarce health resources, denying health services to others who could benefit.”
Lead author, Professor Ben White, director of the Australian Centre for Health Law Research, Queensland University of Technology, said the study was part of a wider research project looking at wide ranging issues of futile treatment at the end of life, from legal, policy, sociological and economic perspectives.
He said the study had identified conceptual consistency in how doctors defined futility, even across specialties.
“We were surprised at the high level of consensus,” he told the limbic. “But despite this consensus, a high level of subjectivity was acknowledged too. A very large number of doctors said ‘what I think is futile, another doctor might not’.”
The study involved 96 semi-structured interviews with doctors from three public hospitals in Brisbane, including emergency (15 doctors), intensive care (12), palliative care (10), oncology (10), renal medicine (9), internal medicine (9), respiratory medicine (9), surgery (8), cardiology (5) and geriatrics (5). Four medical administrators were also included.
Seventy of the 96 doctors referred to the probability of achieving a benefit as part of defining futility. Some commented that assessing the chance of benefit is subjective, and referred to considering colleagues’ opinions, patients’ wishes, and other contextual factors.
“We distilled the following definition from the majority of responses, largely using their words,” the authors wrote.
Futile treatment is treatment that has only a very low chance of achieving meaningful benefit for the patient in terms of: