Are the cases we think to be futile actually so?

Abstract: Much has been written about the concept of non-beneficial treatment (sometimes referred to as medical futility) and the literature is replete with studies that identify this issue as among the most common reasons for ethics consultation. In recognition of the limits of medical prognostication, this sent of concerns has increasingly been qualified as potentially inappropriate treatment. However, little attention has been paid to exploring that epistemic question: are the cases we think to be futile actually so? And if not, what can be learned from studying the outcomes of these patients? Epistemic and ethical questions are often intertwined; as the saying goes, “good facts make good ethics.” This panel will present the current results of an ongoing QA/QI project to determine what outcomes occur in cases categorized as medically futile, or involving potentially non-beneficial treatment. Starting with a dataset of 2,418 consults conducted over the past 40 months, this panel will examine the outcomes of all 235 consults in which concerns about medical futility or potentially non-beneficial treatment were raised. By way of preview, overall mortality for the cohort was 59.1%, and while a large percentage discharged on hospice, a significant portion discharged home. There were a total of 83 permutations among cases using ACECS coding with significant differences in mortality. The panel will involve the audience in dialogue about how these data might inform ethics consultation recommendations.