Futile treatment at the end

J Med Ethics doi:10.1136/medethics-2016-103370

• Clinical ethics

Reasons doctors provide futile treatment at the end of life: a qualitative study

1. Lindy Willmott1, 
2. Benjamin White1, 
3. Cindy Gallois2, 
4. Malcolm Parker3, 
5. Nicholas Graves4,
6. Sarah Winch3, 
7. Leonie Kaye Callaway5, 
8. Nicole Shepherd1, 
9. Eliana Close1

+Author Affiliations

1. ¹Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
2. ²Faculty of Social and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
3. ³School of Medicine, University of Queensland, Brisbane, Queensland, Australia
4. ⁴Queensland University of Technology, Brisbane, Queensland, Australia
5. ⁵Department of Internal Medicine, The Royal Brisbane and Womens Hospital, Herston, Queensland, Australia

1. Correspondence toDr Lindy Willmott, Australian Centre for Health Law Research, Queensland University of Technology, 2 George Street, Brisbane, QLD 4001, Australia; l.willmott@qut.edu.au

• Received 4 January 2016
• Revised 14 April 2016
• Accepted 24 April 2016
• Published Online First 17 May 2016

Abstract

Objective Futile treatment, which by definition cannot benefit a patient, is undesirable. This research investigated why doctors believe that treatment that they consider to be futile is sometimes provided at the end of a patient's life.

Design Semistructured in-depth interviews.

Setting Three large tertiary public hospitals in Brisbane, Australia.

Participants 96 doctors from emergency, intensive care, palliative care, oncology, renal medicine, internal medicine, respiratory medicine, surgery, cardiology, geriatric medicine and medical administration departments. Participants were recruited using purposive maximum variation sampling.

Results Doctors attributed the provision of futile treatment to a wide range of inter-related factors. One was the characteristics of treating doctors, including their orientation towards curative treatment, discomfort or inexperience with death and dying, concerns about legal risk and poor communication skills. Second, the attributes of the patient and family, including their requests or demands for further treatment, prognostic uncertainty and lack of information about patient wishes. Third, there were hospital factors including a high degree of specialisation, the availability of routine tests and interventions, and organisational barriers to diverting a patient from a curative to a palliative pathway. Doctors nominated family or patient request and doctors being locked into a curative role as the main reasons for futile care.

Conclusions Doctors believe that a range of factors contribute to the provision of futile treatment. A combination of strategies is necessary to reduce futile treatment, including better training for doctors who treat patients at the end of life, educating the community about the limits of medicine and the need to plan for death and dying, and structural reform at the hospital level.

We recommend

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