Healthcare News & Insights

What role should hospitals play in curbing ‘futile’ treatments for critically ill patients?

When it comes to caring for critically ill patients, questions often arise, including one that’s inevitable: If the patient’s prognosis is poor, should hospitals recommend treatment be stopped?

AA043380Giving care to patients when the outcome may not be successful is a significant contributor to rising healthcare costs.

According to an article in JAMA Internal Medicine, ICU doctors in just one health system said they provided what they perceived as “futile” care to at least 11% of critically ill patients over a three-month period. In just this short time, the cost of care was estimated at $2.6 million.

Generally, 20% of all healthcare costs in the country are related to critical care interventions, which may lead one to wonder just how much of that is spent on providing “futile” care.

The JAMA article defined futile care as “care interventions that prolong life without achieving an effect that the patient can appreciate as a benefit.”

A majority of physicians surveyed for the article said they were more likely to see patient care as being futile if the burdens to the patients and their families drastically outweighed the benefits of the treatment, according to an article on Philly.com.

Physicians also considered care futile if treatment would never achieve the patient’s goals, if death was imminent or if the patient wouldn’t be able to survive outside of the ICU.

A quote from the JAMA article describes the dilemma for hospitals in a nutshell:

“Treatment that cannot achieve a patient’s goals or that simply maintains a state such as ICU dependence or permanent coma is contrary to professional values, inappropriately uses healthcare resources, and creates moral distress. Nonetheless, the determination of futility is often value laden.”

Because of the ethical issues that arise when determining the futility of giving a patient a certain treatment, it may be impossible for hospitals to say “enough is enough.” Between the pressure from family members to keep a loved one alive and the desire to save every patient that comes through the doors, the decision to continue care is influenced by myriad factors, making it much more difficult.

One patient’s struggle

If a patient is in such dire condition, what responsibility does a hospital have? Should staff encourage patients and their families to continue with standard treatment, or is it better for them to let patients seek out other options, including palliative care, hospice care or more unconventional treatment options?

At the forefront of this debate is an ovarian cancer patient from Texas named Andrea Sloan. As described in an article from CBS News, after finding out she had an advanced form of the disease, she underwent all the standard cancer treatments, including multiple rounds of chemotherapy and radiation, and five surgeries. But none of them could stop her illness from advancing.

So currently, with the support of her oncologist, Sloan is petitioning a major pharmaceutical company, BioMarin, to allow her to take an experimental drug it’s developing.

Although she can’t get into a clinical trial for the drug, the Food and Drug Administration allows drug companies to dispense experimental drugs to patients under a “compassionate use” provision if the person is gravely ill.

BioMarin has refused Sloan’s requests thus far, saying that it’s too early to know if the drug will be effective. To change the company’s mind, she’s taking her fight all the way to Washington DC, and getting support for her cause from the general public via a petition on Change.org.

If a case like this arises where standard treatment isn’t working like it should, how much involvement should hospitals have? Do staffers have an obligation to encourage patients and their families to explore other avenues, or should they continue to provide costly treatments to dying patients, even if they may not produce the desired outcome?

With all the considerations involved, from the financial aspect to the patient’s overall comfort level, it’s not an easy call to make by any means.

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