1 AN INSTITUTIONAL POLICY ON “FUTILE” CARE ELEMENTS FOR SUCCESS

2 GENERAL ORIENTATION PRINCIPLES. TOPICS FOR DISCUSSION. PROCEDURES. RECOURSES. DEFINITION OF RELEVANT TERMS.

3 PRINCIPLES I IDENTIFY GOALS. DEFINE FUTILE TREATMENT FROM PHYSICIAN’S AND PATIENT’S PERSPECTIVES. DISTINGUISH FUTILE FROM INADVISABLE TREATMENTS. IDENTIFY MEDICAL, LEGAL, AND ETHICAL PERSPECTIVES.

4 PRINCIPLES II ROLE OF CLINICAL JUDGMENT. WHETHER TO OFFER TREATMENTS DETERMINED TO BE FUTILE. EXPLANATION OF WHY TREATMENT IS FUTILE. EXPLORE VALUE CONFLICTS AND PROBABILITIES.

5 PRINCIPLES III PATIENT’S RIGHT TO REFUSE TREATMENT. PATIENT’S WISHES OUTRANK SURROGATE’S. ROLE OF AUTHORIZED SURROGATE. NO RIGHT TO DEMAND FUTLE TREATMENT. ADVANCE DIRECTIVES HONORED.

6 TOPICS FOR DISCUSSION I PATIENT’S CONDITION. ASSESSMENT OF PROGNOSIS. GOALS OF TREATMENTS BEING CONSIDERED. REASONABLE CHANCE OF ACHIEVING GOALS. REALISTIC ASSESSEMENT OF BENEFITS.

7 TOPICS FOR DISCUSSION II REALISTIC ASSESSMENT OF BURDENS. DISTINCTION OF BENEFITS AND EFFECTS. PATIENT’S VALUES AND LIFESTYLE EXPECTATIONS. MEANING OF PATIENT’S ADVANCE DIRECTIVE. OPTION TO SEEK TREATMENT ELSEWHERE.

8 PROCEDURES I IDENTIFICATION OF AUTHORIZED SURROGATE. ASSISTANCE OF AUXILIARY CAREGIVERS. INFORMED CONSENT FOLLOWED. DIRECT COMMUNICATION WITH PATIENT WHEN POSSIBLE.

9 PROCEDURES II DIRECT COMMUNICATION WITH AUTHORIZED SURROGATE WHEN NECESSARY. AUTHORITY OF AUTHORIZED SURROGATE. OPPORTU9NITY TO REFUSE TREATMENTS. CONSENSUS OF PROFESSIONALS. NEGOTIATION IF NECESSARY. CLEAR DOCUMENTATION OF FUTILE TREATMENT.

10 RECOURSES SECOND MEDICAL OPINION. AUXILIARY CAREGIVERS TO ADDRESS PATIENT’S EMOTIONAL RESPONSE. HOSPITAL ETHICS COMMITTEE CONSULTATION. APPEAL TO PROBATE COURT.

11 A WEBSITE “A SAMPLE OF THE POSSIBLE”