Approaches To Issues Of Futility

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- Physicians are obligated to fully communicate with patients and surrogates about diagnoses, prognoses, treatment options and risks in a timely manner to allow for informed medical decision making. However, studies show physicians often fail to discuss end of life care preferences with patients. - Determinations of medical futility can be difficult due to uncertainties in prognosis and a lack of understanding of patient values. Physicians are encouraged to have open discussions with patients and surrogates about medical futility and end of life options. - If a surrogate cannot understand the patient's medical situation or make decisions that reflect the patient's wishes, the physician may need to seek a new surrogate or consider the patient's best interests in

Gesundheit & Medizin

Approaches to Issues of Futility Bernard W. Freedman, JD, MPH [email_address]

California Probate Code 4650 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Problems with determination of futility are often caused by physicians ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Physicians are obligated to initiate patient dialogue ,[object Object],[object Object]

Physicians Don’t Generally Discuss End of Life Decisions ,[object Object],[object Object],[object Object],[object Object]

Prolonged Ventilation ,[object Object],[object Object],[object Object],[object Object]

Effective vs. Excessive ,[object Object],[object Object],[object Object],[object Object]

What does the patient/surrogate need to understand when considering futility ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Faith and Dignity ,[object Object],[object Object]

The surrogate is not your patient. ,[object Object],[object Object],[object Object],[object Object],[object Object]

Dealing with Surrogate Decision Makers ,[object Object],[object Object],[object Object]

California Probate Code §4714 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Surrogates and the Therapeutic Privilege ,[object Object],[object Object],[object Object]

Significant Delay must not be permitted to impact on pt’s best interests ,[object Object],[object Object],[object Object]

California Probate Code 4714 ,[object Object],[object Object]

Statutory Right of the Physician regarding the Determination of Futility ,[object Object],[object Object]

California Probate Code §4766 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Disqualification of a Surrogate ,[object Object],[object Object]

Technology can Mask Futility ,[object Object],[object Object]

Do not mask futility with medicine ,[object Object],[object Object],[object Object],[object Object]

Don’t frighten the patient or surrogate with the word “futility.” ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object]

Elicit patient’s valued life activities to help evaluate QOL ,[object Object],[object Object],[object Object]

Time-Limited trials ,[object Object],[object Object]

All Patients or surrogates must : ,[object Object],[object Object],[object Object]

Risks of Demanding Futile Treatment Must be Disclosed ,[object Object],[object Object],[object Object],[object Object]

Acceptable Criteria ,[object Object],[object Object]

Unacceptable Criteria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The Law ,[object Object],[object Object]

California Probate Code 4765 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Judicial Powers: ,[object Object],[object Object]

The Law for Withholding Life Sustaining Treatment ,[object Object],PVS Yes Yes Yes CCE of Pt’s Intent Minimally Conscious

Transparency ,[object Object],[object Object],[object Object]

Seeking Review and Recommendations of Ethics Committees ,[object Object],[object Object],[object Object]

The ethics of terminal care ,[object Object],[object Object]

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