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Type: Journal article
Title: Knowing when to stop: futility in the ICU
Author: Wilkinson, D.
Savulescu, J.
Citation: Current Opinion in Anaesthesiology, 2011; 24(2):160-165
Publisher: Lippincott Williams & Wilkins
Issue Date: 2011
ISSN: 0952-7907
Statement of
Dominic J.C. Wilkinson and Julian Savulescu
Abstract: <h4>Purpose of review</h4>Decisions to withdraw or withhold potentially life-sustaining treatment are common in intensive care and precede the majority of deaths. When families resist or oppose doctors' suggestions that it is time to stop treatment, it is often unclear what should be done. This review will summarize recent literature around futility judgements in intensive care emphasising ethical and practical questions.<h4>Recent findings</h4>There has been a shift in the language of futility. Patients' families often do not believe medical assessments that further treatment would be unsuccessful. Attempts to determine through data collection which patients have a low or zero chance of survival have been largely unsuccessful, and are hampered by varying definitions of futility. A due-process model for adjudicating futility disputes has been developed, and may provide a better solution to futility disputes than previous futility statutes.<h4>Summary</h4>Specific criteria for unilateral withdrawal of treatment have proved hard to define or defend. However, it is ethical for doctors to decline to provide treatment that is medically inappropriate or futile. Understanding the justification for a futility judgement may be relevant to deciding the most appropriate way to resolve futility disputes.
Keywords: intensive care; medical futility; terminal care; treatment refusal; withholding treatment
Rights: © 2011 Lippincott Williams & Wilkins, Inc.
RMID: 0020103920
DOI: 10.1097/ACO.0b013e328343c5af
Appears in Collections:Obstetrics and Gynaecology publications

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