Ethics: Patient Requests for treatment

Question 1

What does futile mean and implications for patient requesting treatments

Answer 1

Futile: Incapable of producing any result; failing utterly of the desired end through intrinsic defect; useless, ineffectual, vain

Common issue of patient requesting treatment which is not seen to be in the best interests of the patients current situation with patients judgement seen as futile
e.g patient coming in with viral infection, asking for antibiotics

Question 2

Three types of futility

Answer 2

Quantitative futility 1, impossible: treatments CANNOT affect any positive physiological change for the condition in question. At a physiological level, the chance of benefiting the patient is 0. The only positive effect that may be had is the placebo effect.

Quantitative futility 2, low probability: Treatments that can conceivably deliver a positive physiological benefit for the
patient, but probability is low.

Qualitative futility: Treatments have a fair probability of delivering a benefit for the patient, but the benefit is very small, and/or the associated disbenefits (e.g. side effects) of the treatment arguably outweigh it.

Question 3

3 questions about futility

Answer 3

Who sets the goals of treatment
Who determines quantitative futility
Should futile treatment always be refused

Question 4

Two opposing positons on doctors role

Answer 4

• Patient is able to make all the decisions for themselves and doctors are there to offer advice but ultimately deliver patients preferred treatment
• Doctors professional integrity requires that they are entitled to refuse to give treatment they see as unethical (side effects, cost). Required to give treatments that are worthwhile

Question 5

Factors to consider when taking a patient request

Answer 5

 What are the risks associated with the treatment?
 What are the other options (are there any other, better options that the patient would forego, or is there no treatment available)
 How serious is the condition? Is this a life-or- death decision?
 What are the costs (financial, staffing; scarce resources e.g organs) of giving the treatment, and who would they fall to (will
the patient bear the costs, or someone else?)
 What are the potential costs to the patient-doctor relationship associated with either acceding to, or refusing, treatment?
-What type of futility is this