Do parents or surrogates have the right to demand treatment deemed futile? An analysis of the case of Baby L

Reasons behind providing futile medical treatments in Iran

Background:

Despite their negative consequences, evidence shows that futile medical treatments are still being provided, particularly to terminally ill patients. Uncovering the reasons behind providing such treatments in different religious and sociocultural contexts can create a better understanding of medical futility and help manage it effectively.

Research objectives:

This study was undertaken to explore Iranian nurses’ and physicians’ perceptions of the reasons behind providing futile medical treatments.

Research design:

This was a qualitative exploratory study. Study data were gathered through conducting in-depth semi-structured personal interviews and analyzed using the conventional content analysis method.

Participants and research context:

Twenty-one nurses and nine medical specialists were recruited purposively from four teaching hospitals affiliated to Tehran University of Medical Sciences.

Ethical considerations:

This study was approved by the Nursing and Midwifery Research Center and the Research Ethics Committee of Tehran University of Medical Sciences. All participants gave informed consent for the research and that their anonymity was preserved.

Findings:

The main theme of the study was “having an obligation to provide medical treatments despite knowing their futility.” This theme consisted of three main categories including patients’ and family members’ request for continuing life-sustaining treatments, healthcare professionals’ personal motives, and organizational atmosphere and structure.

Discussion and conclusion:

Different personal and organizational factors contribute to providing futile medical treatments. Promoting the structure and the function of hospital ethics committees, establishing and developing home care facilities, increasing the number of palliative care centers and hospices, and educating healthcare professionals, patients, and family members about the services and the benefits of such centers can facilitate making wise decisions about continuing or discontinuing treatments which have been labeled as futile.

Nurse Activism in the newborn intensive care unit

Nurses working in a newborn intensive care unit report that treatment decision disagreements for infants in their care may lead to ethical dilemmas involving all health-care providers. Applying Rest’s Four-Component Model of Moral Action as the theoretical framework, this study examined the responses of 224 newborn intensive care unit nurses to the Nurses Ethical Involvement Survey. The three most frequent actions selected were as follows: talking with other nurses, talking with doctors, and requesting a team meeting. The multiple regression analysis indicates that newborn intensive care unit nurses with greater concern for the ethical aspects of clinical practice (p = .001) and an increased perception of their ability to influence ethical decision making (p = .018) were more likely to display Nurse Activism. Future research is necessary to identify other factors leading to and inhibiting Nurse Activism as these findings explained just 8.5% of the variance.

Transition from curative efforts to purely palliative care for neonates: does physiology matter?

OBJECTIVE

To isolate the threshold point in which the goal of care for an infant with life-limiting conditions transitions from curative efforts to purely palliative care.

DESIGN

Descriptive Web-based survey of 285 neonatal physicians and nurses who had participated in care of dying infants.

METHOD

Researcher-developed tool measured multiple palliative care concepts related to transition to purely palliative care, such as identification of infants for whom purely palliative care should be offered; physician and nurse satisfaction with and barriers to the transition process; physiological factors that indicated that the infant was ready for transition to purely palliative care; publication knowledge to guide palliative care; and factors influencing decision making.

RESULTS

The study aim was to identify the physiology involved in coming to the end of life and indicating a transition need for palliative care. But although the respondents were able to identify physiological factors or lethal conditions leading to a transition to purely palliative care, they stated that these factors were not how the goals of care were established. Respondents (96%) stated that parental agreement was the determinant to palliative care transition, and, regardless of neonatal physiological condition, without agreement, curative technological efforts continued. Respondents felt that more education on the palliative care process for both staff and families was necessary to move dignified end-of-life care forward.

CONCLUSIONS

Parents must be our partners when the burden of care to the infant is greater than the benefit. Suggestions to assist both parents and providers are offered.

CLINICAL RELEVANCE

Although this study is based on end-of-life decision making for newborns, the findings may resonate to nurses who care for dying patients of any age group, with any diagnosis, cared for in any type of medical-surgical or critical care unit. The findings describe the American concept of patient and family autonomy and problems that have arisen from the implementation of autonomy in end-of-life decision making regarding withholding/withdrawing therapies that provide artificial life support.