Motivating factors in futile clinical interventions

With modern medical technology, it is now possible to sustain life for prol onged periods in critically ill patients, even when there is no reasonable hope of improvement or achieving the goals of therapy. Such futile and medi cally 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 interv entions, the nature of their motivation, and the role of a timely bioethica l consultation. In a retrospective review, we identified 100 patients of 33 1 bioethical consultations who had futile or medically inappropriate therap y. The average age of patients was 73.5 +/- 32 years (mean +/- 2 SD) with 5 7% being male. Fifty-seven percent of the patients were admitted to the hos pital with a degenerative disorder, 21% with an inflammatory disorder, and 16% with a neoplastic disorder. The family was responsible for futile treat ment in 62% of cases, the physician in 37% of cases, and a conservator in o ne case. Unreasonable expectation for improvement was the most common under lying factor. Family dissent was involved in 7 of 62 cases motivated by fam ily, 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 thera py continued (p < 0.001).