Flashcards on Medical Futility in End-of-Life Care
Medical Futility in End-of-Life Care: A Student's Guide
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Medical futility and end-of-life decision-making
12 cards
Card 1
Question: Who has the moral and legal right to make medical decisions when a patient is mentally competent?
Answer: The patient themselves has the right to make decisions regarding their own care when mentally competent.
Card 2
Question: If a patient is mentally incompetent, how is a surrogate decision-maker identified?
Answer: A surrogate can be legally assigned prior to incapacity (durable power of attorney) or be the next of kin; if none is identifiable, the courts must as
Card 3
Question: What should physicians do when their professional judgment differs from the patient’s or family’s preferences?
Answer: Engage in active dialog with the patient or surrogate, clarify the patient’s values, explain all treatment options respectfully, and use judicious wit
Card 4
Question: When is it appropriate for physicians to request the courts to replace a designated surrogate?
Answer: When the physician believes the surrogate is inflicting harm on the patient; this is an extreme step requiring reflection on moral frames and differen
Card 5
Question: Is it ever appropriate for physicians to dictate medical treatments to patients or families?
Answer: No. It is never appropriate to dictate treatments; physicians should offer viable choices within good patient care and discuss respectfully even when
Card 6
Question: What qualities help physicians respect patient values and avoid miscommunication during end-of-life decision-making?
Answer: Humility, integrity, patience, finesse, avoiding hierarchical/distancing mannerisms, and joining with the family in care decisions.
Card 7
Question: How should physicians explain medical futility to families who want “everything done”?
Answer: State explicitly when there is essentially no chance of meaningful recovery, empathically explain that interventions will not change outcome and may c
Card 8
Question: How can physicians reframe families’ desire to “do everything” in a helpful way?
Answer: Redefine “doing everything” into actions that prevent prolonged suffering and match interventions to the family’s true intentions (e.g., comfort-focus
Card 9
Question: What steps should physicians take if discussions about futility reach a stalemate with the family?
Answer: Consult other providers and/or ethics committees, and if necessary arrange transfer of care to another provider or facility.
Card 10
Question: What is the physician’s obligation if a patient suffers cardiopulmonary arrest before a decision on code status is reached and the family requests ful
Answer: At the moment of arrest, the physician must use best judgment whether CPR is medically indicated; if CPR would be unsuccessful or cause greater harm,