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The Attitudes of Patients With Advanced AIDS Toward Use of the Medical Futility Rationale in Decisions to Forgo Mechanical Ventilation

J. Randall Curtis, Donald L. Patrick, Ellen S. Caldwell, et al.
Abramson Cancer Center of the University of Pennsylvania
Last Modified: November 1, 2001

Reviewers: Li Liu, MD
Source: Archives of Internal Medicine Volume 160:1597-1601, (June) 2000.

Précis: Better physician-patient communication is needed for end-of-life care.

Introduction

During the last decade or two, patients and their families have become increasingly involved in end-of-life decisions, both in hospitals and in the courts. The term medical futility has been used to describe life-or-death situations in which proposed treatments will fail to prolong quality life, achieve the patient's key goals for medical care, achieve a critical physiologic effect on the body, or result in a therapeutic benefit for the patient. In this study, the researchers analyzed the attitudes of patients toward the use of the "medical futility rationale."

Method

A total of 57 patients with advanced acquired immunodeficiency syndrome (AIDS) were asked about the medical futility rationale as it might be applied in their cases. Specifically, they were asked if they thought that it was acceptable for a physician to withhold mechanical ventilation without asking their preference.

Results

• 61% of patients answered that it would definitely be acceptable for their physicians to withhold life support.
• 26% of patients answered that it would probably be acceptable.
• 13% answered that it would definitely not or probably not be acceptable for their physicians to withhold life support under these circumstances.

Discussion

While the majority of patients seem to accept the futility rationale as an acceptable medical practice, there is a large minority who do not. This minority needs to be taken into account. It is common for physicians to be unaware of their patients' opinions about end-of-life issues. This study supports our belief that most treatments can be considered futile only within the context of an individual?s goals for care. More studies are needed to help us understand the wishes about end-of-life care of patients with cancer.