Consensus statement of the Society of Critical Care Medicine's Ethics Committee regarding futile and other possibly inadvisable treatments

Abstract

Objectives: Society must always face the reality of limited medical resources and must find mechanisms for distributing these resources fairly and efficiently. One recent approach for distributing limited medical resources has been the development of policies that limit the availability of futile treatments. The objectives of this consensus statement are as follows: a) to define futility and thereby enable a clear discussion of the issues; and b) to identify principles and procedures for resolving cases in which life-sustaining treatment may be futile or inadvisable.

Data sources: A literature review, synthesis, and committee discussion.

Conclusions: Treatments should be defined as futile only when they will not accomplish their intended goal. Treatments that are extremely unlikely to be beneficial, are extremely costly, or are of uncertain benefit may be considered inappropriate and hence inadvisable, but should not be labeled futile. Futile treatments constitute a small fraction of medical care. Thus, employing the concept of futile care in decision-making will not primarily contribute to a reduction in resource use. Nonetheless, communities have a legitimate interest in allocating medical resources by limiting inadvisable treatments. Communities should seek to do so using a rationale that is explicit, equitable, and democratic; that does not disadvantage the disabled, poor, or uninsured; and that recognizes the diversity of individual values and goals. Policies to limit inadvisable treatment should have the following characteristics: a) be disclosed in the public record; b) reflect moral values acceptable to the community; c) not be based exclusively on prognostic scoring systems; d) articulate appellate mechanisms; and e) be recognized by the courts. Healthcare organizations that control payment have a profound influence on treatment decisions and should formally address criteria for determining when treatments are inadvisable and should share accountability for those decisions.