AN INSTITUTIONAL POLICY ON FUTILE CARE ELEMENTS FOR

AN INSTITUTIONAL POLICY ON “FUTILE” CARE ELEMENTS FOR SUCCESS 1

GENERAL ORIENTATION • PRINCIPLES. • TOPICS FOR DISCUSSION. • PROCEDURES. • RECOURSES. • DEFINITION OF RELEVANT TERMS. 2

PRINCIPLES I • IDENTIFY GOALS. • DEFINE FUTILE TREATMENT FROM PHYSICIAN’S AND PATIENT’S PERSPECTIVES. • DISTINGUISH FUTILE FROM INADVISABLE TREATMENTS. • IDENTIFY MEDICAL, LEGAL, AND ETHICAL PERSPECTIVES. 3

PRINCIPLES II • ROLE OF CLINICAL JUDGMENT. • WHETHER TO OFFER TREATMENTS DETERMINED TO BE FUTILE. • EXPLANATION OF WHY TREATMENT IS FUTILE. • EXPLORE VALUE CONFLICTS AND PROBABILITIES. 4

PRINCIPLES III • PATIENT’S RIGHT TO REFUSE TREATMENT. • PATIENT’S WISHES OUTRANK SURROGATE’S. • ROLE OF AUTHORIZED SURROGATE. • NO RIGHT TO DEMAND FUTLE TREATMENT. • ADVANCE DIRECTIVES HONORED. 5

TOPICS FOR DISCUSSION I • PATIENT’S CONDITION. • ASSESSMENT OF PROGNOSIS. • GOALS OF TREATMENTS BEING CONSIDERED. • REASONABLE CHANCE OF ACHIEVING GOALS. • REALISTIC ASSESSEMENT OF BENEFITS. 6

TOPICS FOR DISCUSSION II • REALISTIC ASSESSMENT OF BURDENS. • DISTINCTION OF BENEFITS AND EFFECTS. • PATIENT’S VALUES AND LIFESTYLE EXPECTATIONS. • MEANING OF PATIENT’S ADVANCE DIRECTIVE. • OPTION TO SEEK TREATMENT ELSEWHERE. 7

PROCEDURES I • IDENTIFICATION OF AUTHORIZED SURROGATE. • ASSISTANCE OF AUXILIARY CAREGIVERS. • INFORMED CONSENT FOLLOWED. • DIRECT COMMUNICATION WITH PATIENT WHEN POSSIBLE. 8

PROCEDURES II • DIRECT COMMUNICATION WITH AUTHORIZED • • • SURROGATE WHEN NECESSARY. AUTHORITY OF AUTHORIZED SURROGATE. OPPORTU 9 NITY TO REFUSE TREATMENTS. CONSENSUS OF PROFESSIONALS. NEGOTIATION IF NECESSARY. CLEAR DOCUMENTATION OF FUTILE TREATMENT. 9

RECOURSES • SECOND MEDICAL OPINION. • AUXILIARY CAREGIVERS TO ADDRESS PATIENT’S EMOTIONAL RESPONSE. • HOSPITAL ETHICS COMMITTEE CONSULTATION. • APPEAL TO PROBATE COURT. 10

A WEBSITE • “A SAMPLE OF THE POSSIBLE” • http: //academic. udayton. edu/Lawrence. Ulrich/315 futlpolme. htm 11