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Modules:

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  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
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    Back to Module 9: Medical Futility
    Due Process Approach to Futility Situations

    Due Process Approach to Futility Situations

    This type of due process approach is strongly recommended by the AMA’s Council on Ethical and Judicial Affairs, and should include the following steps:

    • Earnest attempts in advance
      • Attempt to negotiate an understanding between patient, surrogate, and physician about what constitutes futile care in advance of actual conflict (See Module 8: Sudden Illness)

      • Can pre-empt conflict
    • Joint decision-making
      • To the maximum extent possible, joint decision-making should occur between the patient (parents if the patient is a child) or surrogate and physician

      • Negotiate solutions to disagreements, if they arise, in order to reach a resolution satisfactory to all parties

      • Use the assistance of consultants as appropriate
    • Negotiation of disagreements
      • If disagreements persist, suggest the participation of other consultants, colleagues, and/or a group, such as an institutional ethics committee

      • Additional resources may provide reasoned impartial assessment and evaluation of the conflict

      • Value of ethics committees well described in the medical literature

      • The Joint Commission for Accreditation of Healthcare Institutions requires hospitals to have an ethics committee to aid its physicians, patients, and families to resolve difficult issues

      • The aim--provide maximum possible place for patient autonomy in the conduct of ethical medical practice
    • Involvement of an institutional committee
      • If the institutional review supports the patient’s position and the physician remains unpersuaded, transfer of care to another physician within the institution may be arranged
    • Transfer of care to another physician
      • If the review supports the physician’s position and the patient/surrogate remains unpersuaded, transfer to another institution can be carried out if both the transferring and receiving institutions agree

      • If transfer to another physician in another institution is not possible, the intervention need not be offered

      • However, there needs to be a diligent search for this option
    • Transfer to another institution
      • This process does not solve the problem when no receiving institution can be found

      • The issue of cost of medical care, both to patients and families as well as to the institution and the health care system, is implicit in many of these steps
    • If unable to transfer, the intervention need not be offered
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