Intractable Disagreements About Futility in the PICU

Abstract

Much distress may be felt within the PICU setting regarding the impression that “futile,” or “inappropriate” care is being provided. While a clear definition of futility remains elusive in the medical community, efforts have been made by critical care societies to differentiate between appropriate therapeutic options from potentially inappropriate and inappropriate treatments. Inappropriate treatments should not be offered. However, it can be challenging to know when some benefit is worthy of pursuit (such as a “slow code” for the sake of the family). Families may have cultural or religious values which may translate into a treatment having benefit to them. Healthcare workers typically are most concerned when issues surrounding futility lead to intractable disagreements. These issues seem to occur rarely in pediatric critical care settings, but can lead tension with consequences to medical care. However, intractable disagreements about medical treatments are most frequently resolved through excellent communication. Understanding the values and information that underpin parents’ requests is the first step to resolution and may reveal that a therapy is not truly without some benefit.