The Medical Futility Experience of Nurses in Caring for Critically Ill Patients.

BACKGROUND: Medical futility is a key bioethical concern. In Taiwan, policymakers tend to provide care standards and evaluation guidelines for critically ill and terminal patients whose treatment is medically futile. However, the current status of medical futility for critically ill patients is inadequate, and no consensus currently exists on the definition of medical futility. PURPOSE: The aim of this study was to understand the medical futility experiences of intensive care nurses. METHODS: This qualitative research adopted a phenomenological perspective and was conducted in a medical center and a regional hospital in Central Taiwan. Eight nurses with at least 1 year of nursing tenure who were serving in the intensive care unit were recruited. Purposive and snowball sampling methods were used to conduct one-on-one in-depth interviews. Each of the tape-recorded interviews was transcribed before data analysis. RESULTS: The research results found four themes, including (a) definitions of medical futility and types of patients, (b) considerations of medical futility, (c) the occurrence of medical futility, and (d) nurses' responses to medical futility. The participants indicated that medical futility refers to the point at which the continued provision of treatment does not evidently ease the disease condition of a patient or improve his or her quality of life or when life-sustaining treatment is provided to patients to facilitate the process of death. CONCLUSIONS: This study revealed that the major challenge in clinical cases of medical futility is for physicians, nurses, and patients to communicate effectively together during times of rapid and unanticipated change in patient condition. Thus, events of medical futility may be preventable. Past cases of medical futility involving critically ill patients may serve as references for guiding clinical care, education, and related policy formulation.

[Exploring medical futility].

Although able to extend the life of some critical patients, advanced medical technology is limited in terms of scope and extent of effectiveness. Some patients die despite the best efforts of medical teams. Medical futility describes treatments that are both extremely unlikely to benefit a patient and costly to provide. Clearly defining futile treatments and considering this concept in patient care strategies is important to provide quality patient care. Taiwan is currently formulating a policy on medical futility. While accepting that the term "futile" is used in many different ways and that this term is difficult to define in clinical practice, this article discusses the various ethical views on medical futility and its definition, the debate among these different views, and related research. We hope this article may help medical care staff better understand the importance of medical futility.