Futility: Case 2
An elderly patient with irreversible respiratory disease is in the intensive care unit where repeated efforts to wean him from ventilator support have been unsuccessful. There is general agreement among the health care team that he could not survive outside of an intensive care setting. The patient has requested antibiotics should he develop an infection and CPR if he has a cardiac arrest.
Should a distinction be made between the interventions requested by the patient? Should the patient’s age be a factor?
Like Case 1, Case 2 illustrates possible conflicts that can arise with patients or family members about withholding or withdrawing futile interventions. Ventilator support clearly produces a physiologic effect by contracting and expanding the patient’s lungs with oxygen. Yet this does not suffice to show that the treatment helps the patient, which is medicine’s goal. If the patient will never leave the intensive care unit, does ventilator support constitute a benefit to the patient? A central issue this case raises concerns qualitative futility, namely: does the patient’s quality of life fall well below a threshold considered minimal? If you and other members of the health care team agree that the interventions in question would be qualitatively futile, the goal should be to withdraw or withhold these interventions. Achieving this goal requires working in tandem with the patient and/or family, as well as drawing upon resources, such as social workers, hospital chaplains, and ethics committees. If there is no professional consensus about the futility of a particular intervention, then there is no ethical basis for overriding the requests of patients and/or family members for that intervention.