Dr. Szmuilowicz says he and many other physicians prefer to assess treatment in terms of benefit rather than futility.
“It comes down to what the patient values, and it’s very hard to discuss what we think the patient values if we haven’t talked about it,” he says.
Dr. Kayhan Parsi of Loyola University-Chicago’s Neiswanger Institute for Bioethics sees young physicians struggle with such discussions. Dr. Parsi, who was not involved in the study, was not surprised that 44 percent of doctors cited “inexperience with death and dying.”
As a member of his hospital’s ethics committee, Dr. Parsi meets monthly with medical trainees. “They feel pressure on them to comply with inappropriate treatment, and they don’t know how to address it in an appropriate way,” he said.
Thirty percent of the Australian doctors said they or their colleagues had provided futile treatment due to worries about legal consequences. That factor looms even larger in the U.S., according to Dr. Thaddeus Pope, director of the health law institute at Mitchell Hamline School of Law in St. Paul, Minn.
“Researchers don’t frame the issue in terms of patient safety, but that is a big implication of this study,” says Dr. Pope, who tracks the issue on his Medical Futility Blog.
Dr. Pope urges doctors to present medical options in even-handed ways.
“If physicians are too aggressive, families are going to fall in line,” he tells Reuters Health. “It’s emotionally hard for (families) to pass up what doctors say is a reasonable option. If they knew the real risks, benefits and alternatives, they may not pick the treatment they are receiving.”