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Futility-of-care decisions in the treatment of moribund intensive care patients in a developing country

[L’acharnement thérapeutique pour des moribonds à l’unité des soins intensifs dans un pays en développement]

From the Department of Anaesthesia, Surgery and Surgical Intensive Care, Queen Elizabeth Hospital, Barbados, West Indies.

Address correspondence to: Dr. Seetharaman Hariharan, Department of Anaesthesia and Surgical Intensive Care, Queen Elizabeth Hospital, Barbados, West Indies. Phone: 1-246-436-6450; Fax: 1-246-429-5374; E-mail: hariharan{at}sunbeach.net

Purpose: To analyze the characteristics of moribund patients in a surgical intensive care unit (ICU) and highlight the dilemmas inherent in treating such patients.

Methods: Data on all patients admitted to the surgical ICU during the period of three years from July 1999 to June 2002 were collected prospectively. Data were collected on very ill patients who died, in whom it appeared obvious that treatment could not have improved their condition and whose death could have been anticipated. The case notes were subjected to further analysis to determine the difficulties encountered in managing patients whose therapy was considered to be futile.

Results: Of 662 admissions, 100 (15.1%) died and 30 (4.5%) patients were treated aggressively, even after a prognosis which reflected futile treatment. The overall mean length of stay for survivors was 7.5 ± 9.0 [standard deviation (SD)] days and that for the non-survivors was 12.8 ± 18.1 (SD; P < 0.001). The cost incurred for the treatment of non-survivors was significantly higher than that for the surviving patients. The factors relating to the decisions to continue futile therapy were age of the patient, legal considerations, family wishes and differing opinions between treating physicians.

Conclusion: Consideration of futility during end-of-life care did not receive adequate attention in this unit which incurred additional human and material resources.