An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units

American Journal of Respiratory and Critical Care Medicine 191(11) (2015): 1318-30

13 Pages Posted: 13 Jan 2016

See all articles by Gabriel Bosslet

Gabriel Bosslet

Indiana University - School of Medicine

Thaddeus Mason Pope

Mitchell Hamline School of Law; Queensland University of Technology - Australian Health Law Research Center; Saint Georges University; Alden March Bioethics Institute

Gordon Rubenfeld

Sunnybrook Health Sciences Centre

Bernard Lo

Independent

Robert D. Truog

Harvard University - Harvard Medical School

Cynda Rushton

Johns Hopkins University - Berman Institute of Bioethics

J Randall Curtis

University of Washington, School of Medicine, Harborview Medical Center, Cambia Palliative Care Center of Excellence

Dee Ford

Medical University of South Carolina

Molly Osborne

Independent

Cheryl Misak

University of Toronto

David Au

Independent

Elie Alouzay

Independent

Baruch Brody

Baylor College of Medicine

Brenda Fahy

University of Florida

Jesse Hall

University of Chicago

Josef Kesecioglu

Independent

Alexander Kon

Government of the United States of America - Navy

Katleen Lindell

University of Pittsburgh - University of Pittsburgh Medical Center (UPMC)

Douglas White

University of Pittsburgh

Date Written: June 1, 2015

Abstract

BACKGROUND: There is controversy about how to manage requests by patients or surrogates for treatments that clinicians believe should not be administered.

PURPOSE: This multi-society statement provides recommendations to prevent and manage intractable disagreements about the use of such treatments in intensive care units.

METHODS: The recommendations were developed using an iterative consensus process, including expert committee development and peer review by designated committees of each of the participating professional societies (American Thoracic Society, American Association for Critical Care Nurses, American College of Chest Physicians, European Society for Intensive Care Medicine, and Society of Critical Care).

MAIN RESULTS: The committee recommends: (1) Institutions should implement strategies to prevent intractable treatment conflicts, including proactive communication and early involvement of expert consultants. (2) The term "potentially inappropriate" should be used, rather than futile, to describe treatments that have at least some chance of accomplishing the effect sought by the patient, but clinicians believe that competing ethical considerations justify not providing them. Clinicians should explain and advocate for the treatment plan they believe is appropriate. Conflicts regarding potentially inappropriate treatments that remain intractable despite intensive communication and negotiation should be managed by a fair process of conflict resolution; this process should include hospital review, attempts to find a willing provider at another institution, and opportunity for external review of decisions. When time pressures make it infeasible to complete all steps of the conflict-resolution process and clinicians have a high degree of certainty that the requested treatment is outside accepted practice, they should seek procedural oversight to the extent allowed by the clinical situation and need not provide the requested treatment. (3) Use of the term "futile" should be restricted to the rare situations in which surrogates request interventions that simply cannot accomplish their intended physiologic goal. Clinicians should not provide futile interventions. (4) The medical profession should lead public engagement efforts and advocate for policies and legislation about when life-prolonging technologies should not be used.

CONCLUSIONS: The multi-society statement on responding to requests for potentially inappropriate treatments in intensive care units provides guidance for clinicians to prevent and manage disputes in patients with advanced critical illness.

Keywords: conflict resolution, end-of-life care, ethics committees, futility, shared decision making

JEL Classification: K32, I18

Suggested Citation

Bosslet, Gabriel and Pope, Thaddeus Mason and Rubenfeld, Gordon and Lo, Bernard and Truog, Robert D. and Rushton, Cynda and Curtis, J Randall and Ford, Dee and Osborne, Molly and Misak, Cheryl and Au, David and Alouzay, Elie and Brody, Baruch and Fahy, Brenda and Hall, Jesse and Kesecioglu, Josef and Kon, Alexander and Lindell, Katleen and White, Douglas, An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units (June 1, 2015). American Journal of Respiratory and Critical Care Medicine 191(11) (2015): 1318-30. Available at SSRN: https://ssrn.com/abstract=2701299

Gabriel Bosslet (Contact Author)

Indiana University - School of Medicine ( email )

340 W 10th St #6200
100 South Woodlawn
Indianapolis, IN 46202
United States

Thaddeus Mason Pope

Mitchell Hamline School of Law ( email )

875 Summit Avenue
Room 320
Saint Paul, MN 55105
United States
651-695-7661 (Phone)

HOME PAGE: http://www.thaddeuspope.com

Queensland University of Technology - Australian Health Law Research Center ( email )

2 George Street
Brisbane, Queensland 4000
Australia

Saint Georges University ( email )

West Indies
Grenada

HOME PAGE: http://www.thaddeuspope.com

Alden March Bioethics Institute ( email )

47 New Scotland Ave
MC 153
Albany, NY 12208
United States

HOME PAGE: http://www.thaddeuspope.com

Gordon Rubenfeld

Sunnybrook Health Sciences Centre ( email )

2075 Bayview Ave
Toronto, OR
Canada

Bernard Lo

Independent ( email )

No Address Available

Robert D. Truog

Harvard University - Harvard Medical School ( email )

25 Shattuck St
Boston, MA 02115
United States
617-355-7327 (Phone)

Cynda Rushton

Johns Hopkins University - Berman Institute of Bioethics ( email )

United States

J Randall Curtis

University of Washington, School of Medicine, Harborview Medical Center, Cambia Palliative Care Center of Excellence ( email )

WA
United States

Dee Ford

Medical University of South Carolina ( email )

171 Ashley Avenue
Charleston, SC 29425
United States

Molly Osborne

Independent ( email )

No Address Available

Cheryl Misak

University of Toronto ( email )

Toronto, Ontario M5S 3G8
Canada

David Au

Independent ( email )

No Address Available

Elie Alouzay

Independent ( email )

No Address Available

Baruch Brody

Baylor College of Medicine ( email )

One Baylor Plaza
Apt 510
Houston, TX TX - Texas 77057
United States

Brenda Fahy

University of Florida ( email )

Jesse Hall

University of Chicago ( email )

1101 East 58th Street
Chicago, IL 60637
United States

Josef Kesecioglu

Independent ( email )

No Address Available

Alexander Kon

Government of the United States of America - Navy ( email )

Washington, DC
United States

Katleen Lindell

University of Pittsburgh - University of Pittsburgh Medical Center (UPMC) ( email )

Pittsburgh, PA
United States

Douglas White

University of Pittsburgh ( email )

135 N Bellefield Ave
Pittsburgh, PA 15260
United States

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