End-of-Life Issues

Futility and Aggressive Treatment

Under review

There are many definitions of futility and aggressive treatment. For purposes of this document, a treatment is generally considered “medically futile” or not beneficial if it offers the patient no reasonable hope of cure or improvement or any benefit.

Three questions should be asked in assessing the futility of treatment:

  • Is the proposed procedure in keeping with the patient’s expectations?
  • Does the proposed procedure have adverse effects that must be evaluated in relation to the expected beneficial ones?
  • Will the proposed procedure benefit the patient as a whole?

The futile or aggressive aspect of medical treatment cannot be evaluated without taking into account the point of view of the patient himself and of his family.
Nevertheless, the physician must make every effort to come to an objective judgment in keeping with his or her ethical obligations. In this regard, sections 50 and 58 of the Code of Ethics of Physicians cite the following:

“A physician must only provide care or issue a prescription when these are medically necessary.” (sec. 50)

“A physician must, when the death of a patient appears to him to be inevitable, act so that the death occurs with dignity. He must also ensure that the patient obtains the appropriate support and relief.” (sec. 58)

Even if no legislative provisions anywhere explicitly stipulate so, it is generally agreed that the physician is not obliged to offer care not required by the state of a patient’s health. At the end of life, more specifically, the physician must determine, with the necessary competence and according to the rules of professional ethics, the treatments compatible with a serene and dignified death; he or she must also refuse the imposition of ill-considered treatments by the patient or his family.

In determining end-of-life treatments and their intensity, the physician must use the approach used in seeking a free and informed consent—information, active listening and dialogue. The physician and the patient must come to grips with death in order to discuss it and reach an understanding as to the medically required supportive care the patient wishes to receive.