Simon Kassabian, MD
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L14-0193.
Kassabian S.; Futility: Another Way?. Ann Intern Med. 2014;160:878. doi: 10.7326/L14-5012-6
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Published: Ann Intern Med. 2014;160(12):878.
TO THE EDITOR:
Shah's case presentation (1) is an eloquent and poignant example many clinicians may identify with, at least in an analogous manner. Some clinicians might reject such care, on the basis of moral distress, as improper and unnecessary. Although details involve an extreme of surgical intervention at great cost, its specifics do not differ conceptually from a simpler situation, such as maintaining intravenous hydration in a terminally ill patient so that an out-of-state relative may visit. This is often considered and done.
Palliative care is a team-based approach directed toward the care of both patient and family. Treatment of futility in this case provided that, albeit by extreme example. On the other hand, many palliative clinicians in this situation may have adopted a nonsurgical course as the sole option while remaining supportive of the family with compassionate resolve. Negating surgery only if it has a 0% chance of success with “absolute certainty” as a possible outcome, is an extreme standard not reasonably supported in our profession.
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