Limiting 'Futile' Treatment for Terminal Patients Saves Few Dollars

HANOVER, NH--Results of a multicenter study debunk the view thatlimiting 'futile' life-sustaining treatments for terminally illpatients will produce significant health-care savings. "Cuttingoff care through strict 'futility guidelines' will save few dollarsand not much suffering," said Joanne Lynn, MD, of Dartmouth-HitchcockMedical Center.

In this study of more than 4,000 patients, all of whom were hospitalizedand in an advanced stage of a serious condition, 115 had beengiven less than a 1% chance of surviving for 2 months. The totalhospital bill for these sickest patients was $8.8 million, andprecluding the life-sustaining treatments they received wouldhave saved only $1.2 million (JAGS 42:1202-1207, 1994).

Of these sickest patients, almost 86% died within 5 days of prognosis,and all but one died within 6 months. "For the vast majorityof the sickest patients, death occurs within 5 days of the onsetof serious illness," she said. "For those not quiteso sick, I don't think society is ready to demand that treatmentbe stopped when we still can't predict precisely who will dieand when they will die."

Eliminating futile care for 12 patients would have resulted innearly 75% of the savings in hospital days. But some of thesepatients had a very strong desire to try all possible interventionsto save their lives. Some of them said they definitely wantedresuscitation, based on their religious beliefs. Others were youngpeople who had complications after organ transplant. "Stoppingtreatment quickly is hard to justify in these cases," Dr.Lynn said.

She suggested that a better alternative to futility guidelineswould be to "ensure that decision-making is informed by thepatient's preferences and likely outcomes of care." Healthprofessionals might also provide more support to dying patientsand their families, so that they can more readily stop futiletreatments.