Limiting futile therapy as part of end-of-life care in intensive care units

The debate about medical futility often involves intensive care units where life-support

procedures are routinely applied. Futile therapy is part of end-of-life therapy. In the

discussion about medical futility it is important to distinguish the effect of therapy from

the benefit for the patient. The goal of treatment is not to maintain the function of

an organ, body part or physiological activity, but to maintain health as a whole. Prolonging

ineffective treatment violates the standard of good medical practice.

In 2014, the first Polish guidelines on limiting futile therapy in patients treated in intensive

care units were published. This document presents the official position of intensive

care experts consulted by medical societies of other medical disciplines.

Limitation of futile therapy by withdrawing from already used treatments or withholding

new therapies does not mean that the role of medical personnel has ended. Intensive

care turns into palliative care.

The list of comorbidities showing a statistically significant correlation with medical

futility has been refined. These include heart failure (NYHA III/IV), neoplastic disease and

disseminated neoplastic process, and failure of two or more organs.

The published survey results are devastating; 66-89% of intensive care nurses have provided

futile treatment in their careers. Intensivists estimated that, on average, 20% of

patients in intensive care units receive futile therapy.

There is a need to disseminate standards and procedures related to end-of-life care in

Polish intensive care units.