When ICU Treatment Becomes Futile

Many patients admitted to the intensive care unit (ICU) have no hope of meaningful survival and receive "futile" therapy. When a patient is no longer capable of deciding (so that autonomy is no longer applicable), giving futile treatment is against the three other key ethical principles: beneficence, non-maleficence, and distributive justice. Continuing futile treatments impacts on the patient and his/her family, but also on other patients and society as a whole. In such situations, the goal of intensive care should no longer be to maximize a patient's chances of a good quality of life on discharge but rather to provide them with a dignified and comfortable death. Once a decision has been made that intervention is futile, all on-going treatment should thus be withdrawn except for comfort measures. Good and continuing communication with the family and all members of the healthcare team is an essential aspect of insuring the best possible dying process. In this article, we will explore this complex area and try to provide answers to some of the difficult issues involved, including how futility can be recognized, who should determine that further treatment is futile, and what should be done once it has been decided that further treatment is futile in a particular patient.