When Patients Still Hope, But Doctors See No More Therapeutic Options: Ethical Debates on Futility and Potentially Inappropriate Treatment

Abstract

In everyday clinical practice, difficult situations can arise when physicians reject further therapeutic treatment of seriously ill patients as no longer medically justified, but patients or their representatives do not want to give up hope of improvement, demanding the continuation of therapies and life-sustaining measures. In such cases, is patient autonomy more decisive, or the physician’s assessment regarding the prospects of a prolonged treatment? For ethical counseling or clinical ethics consultation (CEC), it is important that communication is not only about medical facts, risks, and probable treatment prospects, but that moral evaluations also play a role. This chapter shows that ethical integrity is at stake for both sides, i.e., patients or their representatives and medical staff. Ethics consultation can often help establish a balance between patients’ autonomy and physicians’ responsibility and create a mutually acceptable solution if it is able to disentangle the different understandings and evaluations. For this purpose, the medical ethics debate provides helpful insights, for example, regarding the futility concepts applied and the inherent understandings of efficiency, effectiveness, and appropriateness. Distinct procedural models make it possible to find a fair way of dealing with persisting value conflicts. The paper concludes with an outlook on current challenges with this enduring ethical problem.