To provide for substantive reform, any proposed public policy or internal health
care entity effort should address how best to:
1. Facilitate meaningful communication between patients/surrogates and the
patient’s medical team;
2. Facilitate patient education about advance directives, what they mean, when
they come into play and how they would apply;
3. Ensure the patient or his/her surrogate understands the patient’s rights either to
consent to treatment or consent to withhold or withdraw treatment;
4. Ensure that the patient or their surrogate understands the physician and health
care facility have decision-making options regarding continuation of treatment;
5. Facilitate understanding, either through ethics committees, or special
communication teams, between the patient/surrogate and the physician/health care
facility regarding how the patient’s treatment decisions are made and how the health care
facility manages patients in end-of-life-care situations.
Numbers 4 and 5 really spell it all out. When push comes to shove the hospital and it's Ethics Committee has the ultimate decision making ability to terminate life sustaining treatment deemed to be futile. Quoting from the review, "The risk manager explained that when end-of-life conflicts arise, hospital staff and physicians are forced to continue treatments, e.g. dialysis, that they believe have no benefit for the patient." Sure treatment of end stage renal disease is a futile endeavor and patients will ultimately die from it, but to argue that this treatment is of no benefit to the patient is absurd, unless of course it is your contention that life is futile.
Regardless, nearly everything we do in medicine is futile. Tell me the last time you have heard a doctor say that they have cured anything? Other than a few infectious diseases all we do is treat chronic illness that will eventually cause the death of the patient. We talk about cancer in terms of treatment and remission, not cure. If hypertension, diabetes, hyperlipidemia or congestive heart failure is curable why do you have to take medications to treat these ailments for ever? The truth is, nearly everything that I do in the hospital is futile care. The argument in the referenced policy proposal is not about whether a particular treatment option is futile, they all are, it's not even about costs or availability (at least in the short term), it is about patient autonomy. The right of the patient to make decisions about medical care without undue influence by the caregiver. When that is lost the game is over. You will suddenly become a disease and cease to be human.
"Care isn't deemed futile because it doesn't work, but because it does. Hence, it is the patient being declared futile."