Current Attitudes of Anesthesiologists towards Medically Futile Care

Angela Saettele, Joseph Kras

Department of Anesthesiology, Washington University, Saint Louis, USA..

DOI: 10.4236/ojanes.2013.34048                

Abstract

Purpose: To explore anesthesiologists’ perceptions of the reasons underlying why physicians continue to provide care that they consider futile. Methods: A qualitative study was conducted utilizing a grounded theory approach. Four separate focus groups (2 resident physician groups and 2 attending physician groups) were conducted over a three week span. An interview guide was used consisting of a proposed definition of futility and five open-ended questions. Responses to the five open-ended questions were used to guide follow up questions. Transcribed audio recordings were then analyzed. Results: With data reduction, we were able to separate responses into definitions of futility, stories of cases where futile care was provided, and opinions as to the underlying causes of continuing to provide futile care. A variety of opinions was obtained, suggesting the possibility that different groups (surgeons, anesthesiologists, family members) view questions of futility differently. Conclusions: Complete agreement on a definition of futility does not exist. Even when some agreement exists, there is great difficulty in predicting outcomes in individual cases. Future quantitative studies may provide more evidence of trends in underlying reasons for providing futile care. Focused education efforts may then lead to more agreement between all involved.

Keywords

Medical Futility; End of Life Care; Quality of Life; Withdrawal of Care

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	M. S. Niederman and J. T. Berger, “The Delivery of Futile Care Is Harmful to Other Patients,” Critical Care Medicine, Vol. 38, No. 10, 2010, pp. S518-S522. doi:10.1097/CCM.0b013e3181f1cba5
[2]	R. D.Truog, A. S. Brett and J. Frader, “Sounding Board: The Problem with Futility,” New England Journal of Medicine, Vol. 326, No. 23, 1992, pp. 1560-1564. doi:10.1056/NEJM199206043262310
[3]	D. J. Wilkinson and J. Savulescu, “Knowing When to Stop: Futility in the ICU,” Current Opinion in Anesthesiology, Vol. 24, No. 2, 2011, pp. 160-165. doi:10.1097/ACO.0b013e328343c5af
[4]	J. P. Burns and R. D. Truog, “Futility: A Concept in Evolution,” Chest, Vol. 132, No. 6, 2007, pp. 1987-1993. doi:10.1378/chest.07-1441
[5]	B. A. Brody and A. Halevy, “Is Futility a Futile Concept?” Journal of Medicine and Philosophy, Vol. 20, No. 2, 1995, pp. 123-144. doi:10.1093/jmp/20.2.123
[6]	American Society of Anesthesiologists Committee on Ethics, “Syllabus on Ethics,” 1999.
[7]	L. J. Schneiderman, N. S. Jecker and A. R. Jonsen, “Medical Futility: Its Meaning and Ethical Implications,” Annals of Internal Medicine, Vol. 112, No. 12, 1990, pp. 949-954. doi:10.7326/0003-4819-112-12-949
[8]	J. Corbin and A. Strauss, “Basics of Qualitative Research,” 3rd Edition, Los Angeles, Sage, 2008.
[9]	B. Glaser and A. Strauss, “The Discovery of Grounded Theory,” Chicago, Aldine, 1967.
[10]	J. Luce, “A History of Resolving Conflicts over End-of-Life Care in Intensive Care Units in the United States,” Critical Care Medicine, Vol. 38, No. 8, 2010, pp. 1623-1629. doi:10.1097/CCM.0b013e3181e71530
[11]	S. Frick, D. E. Uehlinger and R. M. Zuercher Zenklusen, “Medical Futility: Predicting Outcome of Intensive Care Unit Patients by Nurses and Doctors: A Prospective Comparative Study,” Critical Care Medicine, Vol. 31, No. 2, 2003, pp. 456-461. doi:10.1097/01.CCM.0000049945.69373.7C
[12]	J. Cassell, “Life and Death in Intensive Care,” Temple University Press, Philadelphia, 2005.
[13]	M. Schwarze, C. Bradley and K. Brasel, “Surgical ‘Buy- In’: The Contractual Relationship between Surgeons and Patients That Influences Decisions Regarding Life-Supporting Therapy,” Critical Care Medicine, Vol. 38, No. 3, 2010, pp. 843-848. doi:10.1097/CCM.0b013e3181cc466b
[14]	R. Dresser, “Malignant: Medical Ethicists Confront Cancer,” Oxford University Press, New York, 2012.
[15]	J. Dimsdale, “Psychological Stress and Cardiovascular Disease,” Journal of the American College of Cardiology, Vol. 51, No. 13, 2008, pp. 1237-1246. doi:10.1016/j.jacc.2007.12.024
[16]	F. Iboro, “Perceived Psycho-Emotional Influence of Aesthetics, Affluence and Environmental Sophistication on Employees’ Theft Behaviours in the Workplace,” IFE Psychologia, Vol. 19, No. 1, 2011. http://www.readperiodicals.com/201103/2288643401.html