Volume 189 - Issue 6
What has happened to clinical leadership in futile care discussions?
Authors: Mathew Piercy and Graeme Duke
Med J Aust 2008; 189 (6): 348-349. || doi: 10.5694/j.1326-5377.2008.tb02067.x
Published online: 15 September 2008
Published online: 15 September 2008
To the Editor: In the 7 April issue of the Journal, Murphy encouraged the medical profession to be more proactive about discussing end-of-life care options with family members (or next of kin) with a view to withholding care that may be considered futile by the clinical team.1
While we agree that it is important to offer advice about what course of action the clinical team recommends in a particular case, it is equally important that this advice be based on good evidence and sound clinical judgement. This can be difficult, even for experienced clinicians.
Further, it is unwise to leave the family without any alternative but to accept that advice, because this can lead to distrust and disagreement between the family and the treating team. This is not a matter of acquiescing to a family’s unrealistic expectations — often the prognosis is not clear-cut, and there are times when a planned but limited trial of therapy is warranted. In complex situations, the prognosis often becomes obvious, and families can and do draw comfort from the fact that every effort was made, and are then more willing to accept limitation or withdrawal of therapy.
In the case of withholding cardiopulmonary resuscitation, the treating team has sole responsibility for the medical opinion, but the family should be involved in the final decision and not have it enforced unilaterally.
References
- Murphy BF. What has happened to clinical leadership in futile care discussions? Med J Aust 2008; 188: 418-419. 0_DBABCCEJ