title: Motivating factors in futile clinical interventions.
abstract: With modern medical technology, it is now possible to sustain life for prolonged periods in critically ill patients, even when there is no reasonable hope of improvement or achieving the goals of therapy. Such futile and medically inappropriate interventions may violate both the ethical and medical precepts generally accepted by patients, families, and physicians. In this study, we sought to determine who was primarily responsible for such interventions, the nature of their motivation, and the role of a timely bioethical consultation. In a retrospective review, we identified 100 patients of 331 bioethical consultations who had futile or medically inappropriate therapy. The average age of patients was 73.5 +/- 32 years (mean +/- 2 SD) with 57% being male. Fifty-seven percent of the patients were admitted to the hospital with a degenerative disorder, 21% with an inflammatory disorder, and 16% with a neoplastic disorder. The family was responsible for futile treatment in 62% of cases, the physician in 37% of cases, and a conservator in one case. Unreasonable expectation for improvement was the most common underlying factor. Family dissent was involved in 7 of 62 cases motivated by family, but never when physicians were primarily responsible. Liability issues motivated physicians in 12 of 37 cases where they were responsible but in only 1 of 62 cases when the family was (chi(2) 5 degrees of freedom = 26.7, p < 0.001). When the bioethics consultation resulted in cessation of the therapy, patients died in a median of 2 days as opposed to 16 days if therapy continued (p < 0.001).
authors.affiliation: Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. il1md@home.com
authors.forename: S
authors.initials: S
authors.lastname: Rivera
authors.forename: D
authors.initials: D
authors.lastname: Kim
authors.forename: S
authors.initials: S
authors.lastname: Garone
authors.forename: L
authors.initials: L
authors.lastname: Morgenstern
authors.forename: Z
authors.initials: Z
authors.lastname: Mohsenifar
mesh_terms: D000368:Aged; D001675:Bioethics; D003657:Decision Making; D004992:Ethics, Medical; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D007603:Jurisprudence; D008297:Male; D009042:Motivation; D012017:Referral and Consultation; D012189:Retrospective Studies; D013727:Terminal Care / Q000523:psychology*; D019452:Terminally Ill