Volume 22, Issue 9 (December 2024)
Nursing and Midwifery Journal 2024, 22(9): 728-732 |
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Safdari A, Sharifi A. ETHICAL CHALLENGES IN FUTILE CARE DURING HEALTH CRISES: LESSONS FROM PANDEMIC EXPERIENCES. Nursing and Midwifery Journal 2024; 22 (9) :728-732
URL: http://unmf.umsu.ac.ir/article-1-5281-en.html
URL: http://unmf.umsu.ac.ir/article-1-5281-en.html
1- Department of Nursing, Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
2- Department of Nursing, Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran ,amirsharifi2486@gmail.com
2- Department of Nursing, Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran ,
Abstract: (505 Views)
Dear Editor,
Pandemics and global health crises have posed immense challenges to healthcare and caregiving systems, often accompanied by significant ethical and practical implications. Among these challenges is the management of futile care in situations where resources are scarce and demand exceeds supply (1). For example, the COVID-19 pandemic, as one of the most significant health crises since World War II, left an unprecedented global impact, compelling healthcare organizations and care leaders to confront difficult decisions regarding resource allocation, triage criteria, and levels of care (2).
Based on experiences from pandemics and other health crises, numerous ethical challenges arise for healthcare workers, especially frontline staff, during such events. Decisions regarding the admission or discharge of patients, the ceiling of services provided, and the allocation of resources in the face of shortages and immense pressures often lack straightforward or rapid solutions. These crises not only place unprecedented strain on healthcare leaders and managers but also on medical personnel, particularly nurses. The combination of high demand for care, shortages of critical equipment such as intensive care beds, limited resources, and scientific uncertainties or insufficient information about effective treatments imposes a tremendous emotional and psychological burden on nurses and healthcare teams (1, 3).
During health crises, decisions about the allocation of scarce resources may require stringent prioritization. An example of this includes the extubation of a patient with no clear chance of survival to redirect ventilators to patients with a higher likelihood of recovery (4). This approach, where a holistic perspective replaces the patient-centered approach, sometimes necessitates the limitation or rationing of certain types of care. Many caregivers find this shift in perspective ethically distressing as it contradicts the fundamental principles of patient-centered care and may lead to feelings of helplessness and moral distress (5).
These situations give rise to a phenomenon known as futile care. Futile care refers to interventions with minimal chances of success or those that may be entirely impossible and ineffective due to the patient's condition. In other words, such care involves interventions that neither improve the patient's quality of life nor free them from dependency on complex medical care (6, 7). Futile care can be likened to attempting to carry water in a leaky bucket—an endeavor as fruitless as attempting defibrillation for asystole (8).
Despite scientific advancements and accumulated experiences in patient care during pandemics, uncertainty regarding the outcomes of certain treatments in critical conditions persists. This uncertainty places healthcare teams in challenging situations where decisions to continue or withdraw treatments for patients with unknown diseases and uncertain prognoses become serious dilemmas (3, 4).
One reason for the increase in futile care during health crises is the excessive expectation of recovery and unrealistic demands by patients or their families for specific types of care. Studies indicate that families’ requests for unnecessary treatments and futile care may stem from distrust in medical diagnoses, religious beliefs, or hope for miracles (6, 9). In such situations, it is essential to educate families and explain realities in a comprehensible and empathetic manner, considering their capacity to handle the information. In some cases, legal intervention may even be required to prevent the continuation of futile care.
Futile care has always been a contentious issue between healthcare teams, patients, and families. On one hand, there is the risk of depriving individuals of essential, life-sustaining services; on the other, there is the waste of limited resources that could jeopardize the health and lives of other patients. Providing such care can only be deemed ethical if its potential benefits outweigh its risks (10).
Futile care, especially when nurses and caregivers are compelled to deliver it, imposes significant emotional burdens on them. This type of care not only fosters indifference and reduces the quality of care but also wastes considerable time, energy, and financial resources (6, 11). Moreover, futile care not only adds substantial costs to the healthcare system but also contributes to complications such as antibiotic resistance, pressure ulcers, ventilator-associated pneumonia, and catheter-related infections. In critical conditions where futile care is unavoidable (12), implementing interventions to mitigate its long-term consequences becomes essential.
Among the proposed strategies to reduce futile care and its consequences is a shift toward palliative care, focusing on pain and symptom management (10). Palliative care during health crises not only facilitates symptom control and emotional support but also simplifies decision-making for healthcare teams (13). By prioritizing the emotional, spiritual, and social needs of patients and their families, this approach can help reduce tensions and foster acceptance of realities by both patients and their families.
Developing futile care protocols with the involvement of patients’ families and educating them about the impacts of such care can alleviate the emotional burden and distress experienced by patients and their families. The formation of palliative care teams—including physicians, nurses, social workers, psychologists, psychiatrists, and other specialists—can enhance communication with patients and ensure the delivery of appropriate care.
In healthcare systems, no care is inherently futile; it is the patient’s condition and the crisis context that imbue care with the concept of futility. Decisions regarding the continuation or cessation of care require objective criteria based on the patient’s condition and alignment with the crisis circumstances. Rapid sharing of international experiences, developing treatment protocols tailored to patients’ clinical conditions, and adopting effective palliative approaches can reduce futile care, ease the ethical pressures on caregivers, and improve patients’ quality of life.
Pandemics and global health crises have posed immense challenges to healthcare and caregiving systems, often accompanied by significant ethical and practical implications. Among these challenges is the management of futile care in situations where resources are scarce and demand exceeds supply (1). For example, the COVID-19 pandemic, as one of the most significant health crises since World War II, left an unprecedented global impact, compelling healthcare organizations and care leaders to confront difficult decisions regarding resource allocation, triage criteria, and levels of care (2).
Based on experiences from pandemics and other health crises, numerous ethical challenges arise for healthcare workers, especially frontline staff, during such events. Decisions regarding the admission or discharge of patients, the ceiling of services provided, and the allocation of resources in the face of shortages and immense pressures often lack straightforward or rapid solutions. These crises not only place unprecedented strain on healthcare leaders and managers but also on medical personnel, particularly nurses. The combination of high demand for care, shortages of critical equipment such as intensive care beds, limited resources, and scientific uncertainties or insufficient information about effective treatments imposes a tremendous emotional and psychological burden on nurses and healthcare teams (1, 3).
During health crises, decisions about the allocation of scarce resources may require stringent prioritization. An example of this includes the extubation of a patient with no clear chance of survival to redirect ventilators to patients with a higher likelihood of recovery (4). This approach, where a holistic perspective replaces the patient-centered approach, sometimes necessitates the limitation or rationing of certain types of care. Many caregivers find this shift in perspective ethically distressing as it contradicts the fundamental principles of patient-centered care and may lead to feelings of helplessness and moral distress (5).
These situations give rise to a phenomenon known as futile care. Futile care refers to interventions with minimal chances of success or those that may be entirely impossible and ineffective due to the patient's condition. In other words, such care involves interventions that neither improve the patient's quality of life nor free them from dependency on complex medical care (6, 7). Futile care can be likened to attempting to carry water in a leaky bucket—an endeavor as fruitless as attempting defibrillation for asystole (8).
Despite scientific advancements and accumulated experiences in patient care during pandemics, uncertainty regarding the outcomes of certain treatments in critical conditions persists. This uncertainty places healthcare teams in challenging situations where decisions to continue or withdraw treatments for patients with unknown diseases and uncertain prognoses become serious dilemmas (3, 4).
One reason for the increase in futile care during health crises is the excessive expectation of recovery and unrealistic demands by patients or their families for specific types of care. Studies indicate that families’ requests for unnecessary treatments and futile care may stem from distrust in medical diagnoses, religious beliefs, or hope for miracles (6, 9). In such situations, it is essential to educate families and explain realities in a comprehensible and empathetic manner, considering their capacity to handle the information. In some cases, legal intervention may even be required to prevent the continuation of futile care.
Futile care has always been a contentious issue between healthcare teams, patients, and families. On one hand, there is the risk of depriving individuals of essential, life-sustaining services; on the other, there is the waste of limited resources that could jeopardize the health and lives of other patients. Providing such care can only be deemed ethical if its potential benefits outweigh its risks (10).
Futile care, especially when nurses and caregivers are compelled to deliver it, imposes significant emotional burdens on them. This type of care not only fosters indifference and reduces the quality of care but also wastes considerable time, energy, and financial resources (6, 11). Moreover, futile care not only adds substantial costs to the healthcare system but also contributes to complications such as antibiotic resistance, pressure ulcers, ventilator-associated pneumonia, and catheter-related infections. In critical conditions where futile care is unavoidable (12), implementing interventions to mitigate its long-term consequences becomes essential.
Among the proposed strategies to reduce futile care and its consequences is a shift toward palliative care, focusing on pain and symptom management (10). Palliative care during health crises not only facilitates symptom control and emotional support but also simplifies decision-making for healthcare teams (13). By prioritizing the emotional, spiritual, and social needs of patients and their families, this approach can help reduce tensions and foster acceptance of realities by both patients and their families.
Developing futile care protocols with the involvement of patients’ families and educating them about the impacts of such care can alleviate the emotional burden and distress experienced by patients and their families. The formation of palliative care teams—including physicians, nurses, social workers, psychologists, psychiatrists, and other specialists—can enhance communication with patients and ensure the delivery of appropriate care.
In healthcare systems, no care is inherently futile; it is the patient’s condition and the crisis context that imbue care with the concept of futility. Decisions regarding the continuation or cessation of care require objective criteria based on the patient’s condition and alignment with the crisis circumstances. Rapid sharing of international experiences, developing treatment protocols tailored to patients’ clinical conditions, and adopting effective palliative approaches can reduce futile care, ease the ethical pressures on caregivers, and improve patients’ quality of life.
Type of Study: Letter to editor |
Subject:
پرستاری
References
1. Shnayder MM, Keller EJ, Makary MS. COVID-19 ethics: What interventional radiologists need to know. J Vasc Interv Radiol 2020;31:1720-3. [PMID: 32943297] [DOI:10.1016/j.jvir.2020.07.003] [PMCID: PMC7489880]
2. Cardona M, Anstey M, Lewis ET, Shanmugam S, Hillman K, Psirides A. Appropriateness of intensive care treatments near the end of life during the COVID-19 pandemic. Breathe 2020;16(2). [PMID: 33304408] [DOI:10.1183/20734735.0062-2020] [PMCID: PMC7714540]
3. Peiró T, Lorente L, Vera M. The COVID-19 crisis: Skills that are paramount to build into nursing programs for future global health crises. Int J Environ Res Public Health 2020;17(18):6532. [PMID: 32911727] [DOI:10.3390/ijerph17186532] [PMCID: PMC7558921]
4. Basson MD. Medical resources are scarce, but theories about their allocation are not. Surgery 2020;168(3):392-3. [PMID: 32532467] [DOI:10.1016/j.surg.2020.05.001] [PMCID: PMC7205653]
5. Chu Q, Correa R, Henry TL, McGregor KA, Stoklosa H, Robinson L, et al. Reallocating ventilators during the coronavirus disease 2019 pandemic: Is it ethical? Surgery 2020;168(3):388-91. [PMID: 32616345] [DOI:10.1016/j.surg.2020.04.044] [PMCID: PMC7205622]
6. Morata L. An evolutionary concept analysis of futility in health care. J Adv Nurs 2018;74(6):1289-300. [PMID: 29350780] [DOI:10.1111/jan.13526]
7. Medicine ECotASfR. Fertility treatment when the prognosis is very poor or futile: an ethics committee opinion. Fertil Steril 2019;111(4):659-63. [PMID: 30871767] [DOI:10.1016/j.fertnstert.2019.01.033]
8. Simon JR, Kraus C, Rosenberg M, Wang DH, Clayborne EP, Derse AR. "Futile care"-an emergency medicine approach: Ethical and legal considerations. Ann Emerg Med 2017;70(5):707-13. [PMID: 28754353] [DOI:10.1016/j.annemergmed.2017.06.005]
9. Aghabarary M, Nayeri ND. Reasons behind providing futile medical treatments in Iran: A qualitative study. Nurs Ethics 2017;24(1):33-45. [PMID: 27000190] [DOI:10.1177/0969733016638142]
10. Šarić L, Prkić I, Jukić M. Futile treatment-a review. J Bioeth Inq 2017;14(3):329-37. [PMID: 28634768] [DOI:10.1007/s11673-017-9793-x]
11. Rostami S, Esmaeali R, Jafari H, Cherati JY. Perception of futile care and caring behaviors of nurses in intensive care units. Nurs Ethics 2019;26(1):248-55. [PMID: 28481130] [DOI:10.1177/0969733017703694]
12. Yekefallah L, Ashktorab T, Manoochehri H, Hamid AM. Nurses' experiences of futile care at intensive care units: a phenomenological study. Glob J Health Sci 2015;7(4):235-42. [PMID: 25946928] [DOI:10.5539/gjhs.v7n4p235] [PMCID: PMC4802142]
13. Costantini M, Sleeman KE, Peruselli C, Higginson IJ. Response and role of palliative care during the COVID-19 pandemic: a national telephone survey of hospices in Italy. Palliat Med 2020;34(7):889-95. [PMID: 32348711] [DOI:10.1177/0269216320920780] [PMCID: PMC7218350]
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