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Futility and appropriateness: challenging words, important concepts
  1. D Robin Taylor1,2,
  2. Calvin J Lightbody3
  1. 1 Department of Respiratory Medicine, University Hospital Wishaw, Wishaw, UK
  2. 2 Usher Institute of Population Health Sciences, University of Edinburgh, Edinburgh, UK
  3. 3 Emergency Medicine Department, University Hospital Hairmyres, East Kilbride, UK
  1. Correspondence to Professor D Robin Taylor, Department of Respiratory Medicine, University Hospital Wishaw, Wishaw ML2 0DP, UK; rtaylorscot{at}gmail.com

Abstract

The provision of healthcare is being challenged by a ‘perfect storm’ of forces including an increasing population with multiple comorbidities, high expectations and resource limitations, and in the background, the pre-eminence of the ‘curative medical model’. Non-beneficial (futile) treatments are wasteful and costly. They have a negative impact on quality of life especially in the last year of life. Among professionals, frequent encounters with futility cause moral distress and demoralisation. The factors that drive non-beneficial treatments include personal biases, patient-related pressures and institutional imperatives. Breaking loose from the perceived necessity to deliver non-beneficial treatment is a major challenge. Curative intent should give way to appropriateness such that curative and palliative interventions are valued equally. Goals of treatment should be shaped by illness trajectory, the risk of harms as well as potential benefits and patient preferences. This strategy should be reflected in professional training and the design of acute services.

  • quality in healthcare
  • internal medicine
  • medical ethics
  • adult palliative care

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Footnotes

  • Contributors Each of the named authors contributed to the writing of this manuscript.

  • Funding None.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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