Heeding Community Voices in Medical Futility Guidelines

While problems regarding medical futility have endured abundant commentary, as HEC Forums March 2007 issue illustrates, discussion is far from running out of steam. Conflicts over medically ineffective and inappropriate interventions illustrate how interpersonal failure can accompany technical success. Clearly guidelines are needed for institutional and interpersonal reasons. First, without fair procedures to address and resolve conflict between professional judgment and patient/family wishes, providers have little institutional traction so that judgments become ad hoc and arbitrary. Absent ethics committee input, individual physician judgment rules the day. Second, morally sound guidelines reflect a professional imperative to resolve conflicts in ways that thoughtfully cultivate trust among providers, patients, and their families. With this in mind, under my direction, the center and ethics committee representatives from the Kansas City Regional Ethics Committee Consortium (comprising over twenty-five hospitals) engaged in an eighteen month-long project to craft guideline recommendations. This article will address the dynamics and development of the recommendations, highlighting their merit as both an institutional vehicle and a rich resource of community voices and concerns. In this light, I will present our aims, assumptions, recommended guidelines, insights from community focus groups (the heart of this study), and concluding remarks.