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The Attitudes of Patients With Advanced AIDS Toward Use of the Medical Futility Rationale in Decisions to Forgo Mechanical Ventilation
J. Randall Curtis, MD, MPH;
Donald L. Patrick, PhD, MSPH;
Ellen S. Caldwell, MS;
Ann C. Collier, MD
Arch Intern Med. 2000;160:1597-1601.
Background The medical futility rationale asserts that physicians need not offer their patients therapies that have zero or close to zero probability of success. The rationale is controversial, but it is used in practice.
Objective To examine the attitudes of patients with advanced acquired immunodeficiency syndrome (AIDS) toward the medical futility rationale as it might apply to their medical care.
Methods We conducted a cross-sectional study with interviewer-administered questionnaires. Fifty-seven patients with advanced AIDS (C3 stage AIDS and a CD4 cell count <100/µL) were recruited from academic and private clinics.
Main Outcome Measure Whether patients believe it is acceptable for physicians to withhold mechanical ventilation, without offering it, if physicians determine the intervention is futile.
Results Sixty-one percent of patients (n=35) believed that it was definitely acceptable for their physician to not offer mechanical ventilation if the physician judged this intervention to be futile, and 26% (n=15) believed this was probably acceptable. Less than 10% of patients (n=5) said not offering therapy judged futile was definitely not acceptable. Patients who were less likely to prefer mechanical ventilation in different hypothetical health states were significantly more likely to accept decisions on the basis of futility (P =.003). Health-related quality of life, patient satisfaction with medical care, and patient-clinician communication about end-of-life care were not associated with attitudes toward medical futility.
Conclusions Although the majority of patients with advanced AIDS accept the medical futility rationale, a substantial minority do not. Acceptance of this rationale was associated with wanting less life-sustaining treatment. Physicians invoking the medical futility rationale and hospitals using policies incorporating the medical futility rationale should take into account this diversity in the attitudes toward medical futility.
From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (Drs Curtis and Caldwell), Department of Health Services (Drs Curtis and Patrick), and Division of Infectious Diseases, Department of Medicine (Dr Collier), University of Washington, Seattle.
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