Futile medical care

The concept of futile medical care has been in existence for ages, but still attracts lots of controversy. It is defined as the provision of medical treatment when there is no reasonable hope of improving or curing the patient’s condition. Proponents argue for discontinuation of any treatment that hasn’t been shown to provide any measurable benefits. Stopping futile care isn’t equivalent to active intervention to end life, as withholding care doesn’t hasten the natural progression to death. By its provocative connotations, futile medical care has differing interpretations within different contexts.

Futile medical care was brought into prominence in the early 1990s by the case of Baby K in the United States of America. Baby K was already known to have severe developmental brain abnormalities incompatible with life, long before birth. The mother refused medical advice to terminate the pregnancy, eventually delivering a baby who required intensive care to sustain life. The doctors were at odds with the mother at the futility of providing continued care for a condition that couldn’t be improved or reversed. The courts got involved. Baby K lived to just over two years, leaving a reference source for arguments about the futility of the care she received during her brief lifetime.

There are plenty of other examples of futile care. Common cases involve advanced and incurable terminal cancer. Regardless of repetitive surgery, chemotherapy or radiotherapy, the end result is the same. Cases of brain-dead patients are not too uncommon. They can be sustained on life-support machines for ages, but the eventual goals of such approaches are often hazy.

But how is the decision at the futility of medical interventions arrived at? Who makes such decisions? Is it the doctors, patients, family and relatives, or the state? Arguments against providing futile care include the likelihood of harming patients, and the diversion of resources that could have been utilised in other beneficial ways. Scientific attempts at coming up with decision-aiding algorithms are already in existence. A case in point is in patients with severe burns, and those unresponsive to prolonged resuscitation following cardiac arrests. If the prediction is the inevitable progression to death, the futility of further efforts wins the argument.

As medical advances continue to improve, questions of futility will continue to raise debate. The arguments aren’t just scientific. There are issues about ethics, religion, beliefs and social-cultural expectations. There’s even been an argument about making futile care a market commodity, not unlike the purchase of luxury goods and lifestyles. If the purchaser can afford futile care, regardless of how much it costs or it’s benefits, they can as well have it. The caveat should be to ensure equitable access of similar care to other patients with treatable conditions.

The will to live appears to be very strong even in situations deemed hopeless by clinicians. This can never be ignored, and will remain the main driver for futile medical care.

Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist. amurage@mygyno.co.ke