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Three Patients pp 189-203 | Cite as

Discussion of the Medical Aspects of Futility

  • David Crippen

Abstract

The clinical accuracy of peer-reviewed medical literature is evolving rapidly and with it the potential to learn a great deal about achieving benefit in critical care.1 The advent of the Internet and electronic bulletin boards led to real-time contact with a multinational pool of working physicians, as well as up-to-the-minute data regarding patient care on a multinational platform.2 This has created a new global medical village, in which the furthest citizens reside just around the corner. In 1994, CCM-L (http://ccm-l.med.edu), the first medical bulletin board dedicated to the specialty of critical care medicine, was founded. At the time of this writing, a multinational contingent of about 1000 CCM-L subscribers, including physicians, pharmacists, nurses, other interested providers, medical ethicists, and researchers, access a sophisticated mail server located at the University of Pittsburgh in Pennsylvania. About half live and work outside the United States. The purpose of CCM-L is to provide a forum to discuss, and to maintain a data bank for, the holistic daily care of the patient as it pertains to the intensive care setting. Included in the discussion are problems associated with limitation, withholding, and withdrawal of life support. CCM-L provided the platform from which the opinions that form this work were drawn.

Keywords

Critical Care Critical Care Physician Brain Failure Health Care Consumer Fair Game 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Wu AW, Damiano AM, Lynn J, et al: Predicting future functional status for seriously ill hospitalized adults. The SUPPORT prognostic model. Ann Intern Med 1995;122:342–50.PubMedGoogle Scholar
  2. 2.
    Crippen D: Critical care and the Internet. A clinician’s perspective. Crit Care Clin 1999;15:605–14, vii.PubMedCrossRefGoogle Scholar
  3. 3.
    Hiatt HH: Protecting the medical commons: who is responsible? N Engl J Med 1975;293:235–41.PubMedCrossRefGoogle Scholar
  4. 4.
    Berenson RA: Intensive Care Units (ICUs): Clinical Outcomes, Costs and Decisionmaking (Health Technology Case Study 28). Washington, DC: Office of Technology Assessment, 1984.Google Scholar
  5. 5.
    Engelhardt HT Jr, Rie MA: Intensive care units, scarce resources, and conflicting principles of justice. JAMA 1986;255:1159–64.PubMedCrossRefGoogle Scholar
  6. 6.
    H.J. RES 29. March 6, 2001.Google Scholar
  7. 7.
    A controlled trial to improve care for seriously ill hospitalized patients. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA 1995;274:1591–8.Google Scholar
  8. 8.
    Wanzer SH, Adelstein SJ, Cranford RE, et al: The physician’s responsibility toward hopelessly ill patients. N Engl J Med 1984;310:955–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Chelluri L, Pinsky MR, Donahoe MP, et al: Long-term outcome of critically ill elderly patients requiring intensive care. JAMA 1993;269:3119–23.PubMedCrossRefGoogle Scholar
  10. 10.
    Knaus WA, Draper EA, Wagner DP, et al: Prognosis in acute organ-system failure. Ann Surg 1985;202:685–93.PubMedCrossRefGoogle Scholar
  11. 11.
    Breen CM, Abernethy AP, Abbott KH, et al: Conflict associated with decisions to limit life-sustaining treatment in intensive care units. J Gen Intern Med 2001;16:283–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Wenger NS, Kanouse DE, Collins RL, et al: End-of-life discussions and preferences among persons with HIV. JAMA 2001;285:2880–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Field BE, Devich LE, Carlson RW: Impact of a comprehensive supportive care team on management of hopelessly ill patients with multiple organ failure. Chest 1989;96:353–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Burrows R: Removal of life support in intensive care units. Med Law 1994;13:489–500.PubMedGoogle Scholar
  15. 15.
    Francis LP: Legal rights to health care at the end of life. JAMA 1999;282:2079.Google Scholar
  16. 16.
    Consensus statement of the Society of Critical Care Medicine’s Ethics Committee regarding futile and other possibly inadvisable treatments. Crit Care Med 1997;25:887–91.Google Scholar
  17. 17.
    Pronovost P, Angus DC: Economics of end-of-life care in the intensive care unit. Crit Care Med 2001;29:N46–51.PubMedCrossRefGoogle Scholar
  18. 18.
    Taylor M: Investigation heats up. Probe of alleged kickbacks at Tenet hospitals escalates. Mod Healthc 2001;31:20–1.Google Scholar
  19. 19.
    Kleinke JD: Bleeding Edge: The Business of Health Care Delivery in the New Century. Gaithersburg, MD: Aspen, 1998.Google Scholar
  20. 20.
    Daniels N: Why saying no to patients in the United States is so hard. Cost containment, justice, and provider autonomy. N Engl J Med 1986;314:1380–3.PubMedCrossRefGoogle Scholar
  21. 21.
    Wennberg J: The paradox of appropriate care. JAMA 1987;258:2568–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Grumet GW: Health care rationing through inconvenience. The third party’s secret weapon. N Engl J Med 1989;321:607–11.PubMedCrossRefGoogle Scholar
  23. 23.
    Lynn J, Teno JM, Phillips RS, et al: Perceptions by family members of the dying experience of older and seriously ill patients. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Ann Intern Med 1997;126:97–106.PubMedGoogle Scholar
  24. 24.
    Marbella AM, Desbiens NA, Mueller-Rizner N, et al: Surrogates’ agreement with patients’ resuscitation preferences: effect of age, relationship, and SUPPORT intervention. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. J Crit Care 1998;13:140–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Von Stetina vs Florida Medical Center. Florida Law Weekly. May 24, 1985.Google Scholar
  26. 26.
    Crippen D: Agitation in the ICU, part one: anatomical and physiologic basis for the agitated state. Crit Care 1999;3:R35–46.PubMedCrossRefGoogle Scholar
  27. 27.
    Crippen D: Understanding the neurohumoral causes of anxiety in the ICU. Clinical consequences include agitation, brain failure, delirium. J Crit Illn 1995;10:550–5, 559–60.PubMedGoogle Scholar
  28. 28.
    Crippen DW: Neurologic monitoring in the intensive care unit. New Horiz 1994;2:107–20.PubMedGoogle Scholar
  29. 29.
    Scragg P, Jones A, Fauvel N: Psychological problems following ICU treatment. Anaesthesia 2001;56:9–14.PubMedCrossRefGoogle Scholar
  30. 30.
    Crippen D: Life-threatening brain failure and agitation in the intensive care unit. Crit Care 2000;4:81–90.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • David Crippen

There are no affiliations available

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