Hospital policy on medical futility - does it help in confl ict resolution and ensuring good end-of-life care?

Abstract

Introduction: This paper aimed to ascertain if hospital policy on medical futility helps in confl ict resolution, and in ensuring good end-of-life care. Materials and Methods: Literature on the subject published in the last 5 years was identifi ed through Pubmed, and those with empirical data pertaining to the outcomes of interest were examined. A systematic analysis was not possible as papers varied greatly in aims, designs, outcomes and their measures. Instead, the outcomes of representative papers were described and discussed. Results: There is a widespread use of policies and guidelines based on the concept of medical futility. Confl icts are rare and appear to arise primarily from the manner in which policies are implemented. End-of-life care appears to be improving as evidenced by a signifi cant number of deaths occurring following: (i) discussions involving patient, family, healthcare team members; (ii) cessation of intensive care and (iii) cessation of institution of palliative care. Deaths are increasingly taking place in the presence of family and outside the intensive care wards. Finally, post mortem audit of processes and practices indicate (i) compliance but in a limited manner with policies and recommended guidelines, (ii) family satisfaction and (iii) identify areas where improvement in end-of-life (EOL) care can be effected. Key areas are in improving education of, communication with, and documentation by all stakeholders. Conclusion: Hospital policies on medical futility have helped to resolve confl icts and improve end-of-life care. Prospective, multicentre and controlled trials will be useful in determining the value of specifi c interventions, obtaining generalisable data and facilitating implementation of better end-of-life care models.