Use of life-sustaining or invasive interventions in patients
in a persistent vegetative state or who are terminally ill may only
prolong the dying process. What constitutes futile intervention remains
a point of controversy in the medical literature and in clinical
practice. In clinical practice, controversy arises when the patient or
proxy and the physician have discrepant values or goals of care. Since
definitions of futile care are value laden, universal consensus on
futile care is unlikely to be achieved. Rather, the American Medical
Association Council on Ethical and Judicial Affairs recommends a
process-based approach to futility determinations. The process includes
at least 4 steps aimed at deliberation and resolution including all
involved parties, 2 steps aimed at securing alternatives in the case of
irreconcilable differences, and a final step aimed at closure when all
alternatives have been exhausted. The approach is placed in the context
of the circumstances in which futility claims are made, the
difficulties of defining medical futility, and a discussion of how best
to implement a policy on futility.
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