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Determinations of Futility

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  1. Determinations of Futility Rels 300 / Nurs330 27 November 2013 300/330 - appleby

  2. JOINT STATEMENT ONRESUSCITATIVE INTERVENTIONS This joint statement was approved in 1995 by: • the Canadian Healthcare Association • the Canadian Medical Association • the Canadian Nurses Association and • the Catholic Health Association of Canada • in cooperation with the Canadian Bar Association 300/330 - appleby

  3. “There is no obligation to offer a person futile or non-beneficial treatment. Futile and non-beneficial treatments are controversial concepts when applied to CPR. Policy-makers should determine how these concepts should be interpreted in the policy on resuscitation, in light of the facility’s mission, the values of the community it serves, and ethical and legal developments. “For the purposes of this document and in the context of resuscitation, “futile” and “non-beneficial” are understood as follows:” 300/330 - appleby

  4. a treatment is “medically” futile or non-beneficial if: • it offers no reasonable hope of recovery or improvement • the person is permanently unable to experience any benefit “In other cases the utility and benefit of a treatment can only be determined with reference to the person’s subjective judgementabout his or her overall well-being.” 300/330 - appleby

  5. CPR, DNRs & FUTILITY CPR as a treatment option “The efficacy of CPR in restoring cardiac and respiratory functioning varies from nil to very high, depending on a number of factors. On the basis of research studies of such outcomes four general categories can be distinguished: a. people who arelikely to benefitfrom CPR; b. people for whombenefit is uncertain; c. people for whombenefit is unlikely; and, d. people who almost certainly will not benefit.” 300/330 - appleby

  6. 10 March 2008 When is treatment futile? “On this week's White Coat, Black Art, I visited the Halifax Infirmary, part of Capital Health, where I spoke with doctors and nurses from the emergency department and the intensive care unit. You may be surprised to learn that doctors and nurses don't turn to studies and charts to tell them when the end of the road is nigh. It may disturb you to know that docs and nurses say they just know medical futility when they see it.” whitecoat_20080310_4958.mp3 300/330 - appleby

  7. Who should determine futility? What value judgements are involved in judging treatment effectiveness and making determinations of futility? By whom? • Do patient, family, and caregiver values and preferences usually coincide? 300/330 - appleby

  8. How to move forward If patients make treatment demands that health care providers oppose, how can such conflicts be resolved? Does recourse to the “patient’s interests” necessarily work? Why, or why not? Should medical professionals be obliged to provide treatment which they view as inappropriate, ineffective, potentially harmful, and ultimately futile? 300/330 - appleby

  9. • October 2010, Mr. Hassan Rasoulideveloped meningitis and severe brain damage following surgery to remove a brain tumour • Mr. Hassan Rasouli has been in a persistent vegetative/minimally conscious state and ventilator dependent since • Attending physicians determined that CPR and intensive life support was not the standard of care for patients with this diagnosis, as prolonged medical benefit could not be realized. • Ms. Salasel [wife and surrogate decision-maker] disagrees • She believes that where there is life, there is hope; she does not believe that he is in a state of permanent and irreversible unconsciousness • Superior Court Ontario – 9 March 2011: “doctors require consent when withdrawing life-support”→Doctors appealed • The Court of Appeal ruled that physicians can withhold or withdraw life sustaining treatments that are medically ineffective without consent 300/330 - appleby

  10. This ruling was appealed to the Supreme Court of Canada • 18 October 2013; SCC: 5 to 2 split decision • Majority: consent must be sought from a patient or substitute decision maker to withdraw life support • Minority: the HCCA does not permit a patient to dictate treatment…that is medically futile • Rasoulilife-support case:SCC rules consent needed before ending treatment •[2:47] 300/330 - appleby