DETERMINING FUTILE TREATMENTS SEEKING THE BEST INTERESTS OF THE PATIENT

DEFINITIONS FUTILITY; MEDICAL FUTILITY THE INABILITY TO ACCOMPLISH AN INTENDED GOAL MEDICAL FUTILITY ANY CLINICAL INTERVENTION WHICH A PHYSICIAN, RELYING ON THE MEDICAL LITERATURE AND HIS/HER CLINICAL JUDGMENT (WEIGHING RELEVANT PROBABILITIES], DETERMINES WILL BE UNABLE TO ACCOMPLISH A PHYSIOLOGICAL GOAL WHICH WILL BENEFIT THE PATIENT. PERMANENT DEPENDENCE ON INTENSIVE CARE INTERVENTIONS

DEFINITIONS PERSONALLY-DETERMINED FUTILITY; CLINICAL FUTILITY ANY EFFORT TO ACHIEVE A RESULT, WHICH MAY BE POSSIBLE BUT WHICH DOES NOT FALL WITHIN THE PERSONALLY-DETERMINED GOALS OF THE PATIENT (OR SURROGATES WHO CAN LEGITIMATELY SPEAK FOR PATIENTS). CLINICAL FUTILITY A JUDGEMENT, WHICH INTEGRATES CONSIDERATIONS OF MEDICAL FUTILITY AND PERSONALLY-DETERMINED FUTILITY INTO A UNIFIED WHOLE AND WHICH REFLECTS THE INTERESTS OF THE TOTAL PATIENT AND THE OTHER INDIVIDUALS WHO ARE LEGITIMATE PARTICIPANTS IN THE DECISIONAL PROCESS.

CLINICAL JUDGMENT THE JUDGMENT MADE BY A HEALTHCARE PROFESSIONAL, WHICH TAKES INTO ACCOUNT THE OBJECTIVE FINDINGS, WHICH SUPPORT A DIAGNOSIS AND PROGNOSIS AND WEIGHS THEM IN LIGHT OF THE PROFESSIONAL’S EXPERTISE AND CLINICAL EXPERIENCE TOGETHER WITH THE PECULIAR CIRCUMSTANCE OF AN INDIVIDUAL PATIENT. SUCH JUDGMENTS ARE MADE WITH DUE REGARD FOR A REASONABLE DEGREE OF MEDICAL CERTAINTY AS DETERMINED IN ACCORDANCE WITH REASONABLE MEDICAL STANDARDS.

INADVISABLE TREATMENTS COMPARE WITH FUTILE TREATMENTS EXTREMELY UNLIKELY TO BE BENEFICIAL BENEFICIAL EFFECTS BUT EXTREMELY COSTLY UNCERTAIN OR CONTROVERSIAL BENEFIT FUTILE TREATMENTS HAVE NO PHYSIOLOGICAL BENEFIT

PROCESSING FUTILITY CLEARLY IDENTIFY THE GOAL OF THE INTERVENTION PHYSIOLOGICAL/METABOLIC FUNCTIONAL VALUE CALCULATE AND INTERPRET PROBABILITIES CLARIFY VALUES SET PARAMETERS FOR REASONABLE GOALS SPECIFIC TIME-LIMITED GOAL WITNESS A PARTICULAR EVENT ASSESS BENEFITS REALISTICALLY DISTINGUISH BETWEEN BENEFIT AND EFFECT LIMITATIONS ON AUTONOMY THE SCOPE OF THE RIGHT TO REFUSE TREATMENT IS GREATER THAN THE RIGHT TO CHOOSE/DEMAND TREATMENT CHOICES ONLY AMONG MEDICALLY INDICATED TREATMENTS INFORM PATIENTS BUT DO NOT OFFER TREATMENT --- INFORMATION WITHOUT CONSENT