Keeping Up - What's New

Julia MacMillan APRN ACNS-BC, ACHPN
Palliative Care Coordinator
Danbury Hospital
Co-Chair, DH Ethics Committee

Medical Futility

Medical futility refers to a treatment or intervention that, within a reasonable degree of medical certainty, is seen to be potentially inappropriate or without clinical benefit to the patient.

At times, disagreements may occur between patients and families regarding treatment options that may not be clinically beneficial or medically appropriate for the patient. They are rare, but when they occur, it can cause emotional and moral distress for all parties. Physicians may have a moral objection to providing treatment that is not beneficial and perhaps, even harmful to their patient. Until now, there has been no policy or institutional mechanism to deal with requests deemed medically inappropriate at either Danbury or Norwalk Hospitals.

Open communication between the medical team and the patient or surrogate is imperative when medical futility develops, but if a disagreement occurs and the dispute cannot be resolved, it should be managed through an institutional mechanism to provide a clear process to help the clinician and the patient/surrogate.

After much hard work, the Ethics Committees at Norwalk Hospital and Danbury Hospital, a diverse working group, has now collaboratively developed a Futility Policy.

These guidelines apply to all patient care units and staff at Western Connecticut Health Network and are based on the recommendations of the Council on Ethical and Judicial Affairs of the American Medical Association. In summarizing the document, the procedure is a step by step process that states that all available resources should be included, such as the clinical team (nurses, consultants, and other health care providers involved in the patient’s care, Social Work, Ethics Committee, Risk, Legal, and Vice President of Medical Affairs to try to come to a resolution. A second opinion should be sought, and documented, in the medical record. An Ethics Consultation should take place.

If these steps have taken place and there is still no resolution, then the Chair of the Respective Department, in consultation with the Vice President of Medical Affairs, will review the case and may determine if the treatment in question should be provided or discontinued. Neither the hospital nor the attending physician is obligated to provide the treatment in question; however, appropriate standards of medical care will continue. Finally, if a decision is made to limit or discontinue treatment, a period of time will be given to the patient/surrogate to allow them to explore options such as legal proceedings, or transfer to another facility.

These issues are usually emotion-packed and difficult. By having a policy in place, patients’ access to professional medical and legal services is protected and the clinicians’ moral integrity is protected.

The Futility Policy is on the Intranet. lease feel free to call or email Dr. Charles Herrick, Julia MacMillan APRN (Co-Chairs of the Danbury Hospital Ethics Committee) or Dr. Andrea Peterson (Co-Chair of Norwalk’s Ethics Committee) if you have any questions.

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