Idiopathic proximal hemimegacolon is a disorder characterized by bowel dilatation proximal to the splenic flexure. It is a very rare and therefore a poorly understood clinical entity. This report describes a case of idiopathic proximal hemimegacolon in a 44-year-old woman. The patient suffered from 2 episodes of constipation and bowel dilatation over 4 years and was successfully treated by medical therapy.
Adult ; Colon, Transverse ; Constipation ; Dilatation ; Female ; Humans ; Medical Futility

With development of new techniques for medical intervention, there has been a big dilemma for physicians about their decision when to stop treatment. Application of life-sustaining device sometimes results in a prolongation of painful period (dying process) for patients. Regarding the role of physician in the end-of-life decision, there could be two extremes : euthanasia vs. therapeutic tenacity (futility or accanimento terapeutico). Either extreme has its own limitations. One of possible solutions is an appropriate application of withholding and withdrawing interventions. However, several considerations are necessary for this. First, the clinical aspect of decision is whether a certain management is proportionate or non-proportionate for a given situation. If there is a chemotherapy regimen that has an efficacy of 15% partial response rate with side effects in the previous study, is it propotionate or non-proportionate treatment for advanced cancer patients? Other aspects of decision is regarding ethical, economical, and legal issues. One type of circumstances that may prompt claims of futility is the discrepancy between the values or goals of involved parties. Other concerns on futility issues are ① is it easy to break the bad news to dying patients in Korean culture? (communication problems at various levels) ② is social welfare system adequate enough not to interfere with a fair decision? Values on the issues like therapeutic decision and withholding life-sustaining treatments in terminally ill cancer patients are discordant between physicians and family members. To resolve controversies on the role of physicians as well as those of patients and their family members should be considered in the final decision.
Drug Therapy ; Euthanasia ; Humans ; Medical Futility ; Social Welfare ; Terminally Ill*

INTRODUCTIONThis paper aimed to ascertain if hospital policy on medical futility helps in conflict resolution, and in ensuring good end-of-life care.

MATERIALS AND METHODSLiterature on the subject published in the last 5 years was identified through Pubmed, and those with empirical data pertaining to the outcomes of interest were examined. A systematic analysis was not possible as papers varied greatly in aims, designs, outcomes and their measures. Instead, the outcomes of representative papers were described and discussed.

RESULTSThere is a widespread use of policies and guidelines based on the concept of medical futility. Conflicts are rare and appear to arise primarily from the manner in which policies are implemented. End-of-life care appears to be improving as evidenced by a significant number of deaths occurring following: (i) discussions involving patient, family, healthcare team members; (ii) cessation of intensive care and (iii) cessation of institution of palliative care. Deaths are increasingly taking place in the presence of family and outside the intensive care wards. Finally, post mortem audit of processes and practices indicate (i) compliance but in a limited manner with policies and recommended guidelines, (ii) family satisfaction and (iii) identify areas where improvement in end-of-life (EOL) care can be effected. Key areas are in improving education of, communication with, and documentation by all stakeholders.

CONCLUSIONHospital policies on medical futility have helped to resolve conflicts and improve end-of-life care. Prospective, multicentre and controlled trials will be useful in determining the value of specific interventions, obtaining generalisable data and facilitating implementation of better end-of-life care models.

Conflict (Psychology) ; Ethics, Medical ; Humans ; Medical Futility ; ethics ; psychology ; Organizational Policy ; Palliative Care ; ethics ; methods ; standards

It is natural for all human beings to die; hence, death is an inevitable event. However, advances in medical technology are changing the meaning of natural death. These advanced treatments provide the capability to intervene at the time of death and to reshape the circumstances around natural death, by sustaining human life. However, it is extremely difficult to judge when treatment is futile for the patient's best interests. It is therefore recommended to make time to discuss the concept of medical futility during the course of caring for a critically ill patient. Despite the expectations and efforts of the patient, the patient's family, and medical staff, the patient will eventually, have a ‘hopeless’ medical condition. Most discussions about decision-making in end-of-life treatment have neen ethical debates focused on the patient's self-determination and best interest in the context of concepts such as euthanasia or death with dignity. However, such discussions are insufficient for resolving the wide variety of circumstances that occur in clinical settings. Instead, the various ethical dilemmas inherent to end-of-life care should be approached by educating medical teams, patients, and their families about how to recognize medical futility. Furthermore, it is important to optimize the balance between the rights of patients and the responsibility of physicians.
Critical Illness ; Euthanasia ; Humans ; Medical Futility ; Medical Staff ; Personal Autonomy ; Right to Die ; Withholding Treatment

BACKGROUND: The difficulty in advancing the epidural catheters to hoped-for levels after successful demonstration of loss of resistance in the epidural space has well been known. This study was undertaken to determine the optimal distance that a catheter could be threaded into the epidural space without coiling. METHODS: An epidural catheter (single orifice, end hole) was inserted at L2-3 or L3-4 interspace with bevel of the needle directed either cephalad (n=15) or caudad (n=25). After injection of 1 ml of iohexol dye through the catheter, fluoroscopy was taken to determine the position of catheter tip. The findings of 40 epidurographies were analysed. RESULTS: The lengths of catheters threaded into the epidural spaces without coiling were 3.0+/-1.3 cm (mean+/-SD) and varied from 1.0 to 8.0 cm. Only 10 per cent of the catheters threaded without coiling 5 cm beyond the intervertebral space of insertion. No statistical significance was seen between the length threaded without coiling for catheters in the cephalad direction (2.9+/-1.1 cm) and in the caudad direction (3.0+/-1.3 cm). Although the Tuohy needle was inserted using the midline approach with the intention of positioning the catheter in the midline, only in 34.8 per cent was the catheter indeed situated in the midline. Conclusion : This study shows the futility of attempting to thread a catheter more than 3 cm within the epidural space. In lumbar epidural anesthesia, it is desirable to insert a catheter at the nearest possible spinal level.
Anesthesia, Epidural ; Catheters* ; Epidural Space* ; Fluoroscopy ; Intention ; Iohexol ; Medical Futility ; Needles

PURPOSE: To provide practical data for bioethics education, we identified correlations between recognition of good death, attitude towards withdrawal of meaningless life-sustaining treatment, and attitude towards euthanasia in nurses. METHODS: Using convenience sampling, we recruited 218 nurses who had at least six-month work experience in one of the six general hospitals with 500 or more beds in Seoul, Busan, and Gyeongsang province. All participants understood the purpose of the study and agreed to take part in the study. The research tools used included the Concept of Good Death Measure (CoGD), the measurement tool for attitudes towards withdrawal of meaningless life-sustaining treatment (WoMLST), and the measurement tool for attitudes towards euthanasia. Data were analyzed using an Independent t-test, one-way ANOVA, and Pearson's correlation coefficient using SPSS 21 for Windows. RESULTS: Nurses had normal levels on CoGD, WoMLST, and attitudes towards euthanasia. Nurses' CoGD, WoMLST, and euthanasia scores significantly differed depending on their education level, working period, and the importance of religion to them. A negative correlation was found between the CoGD and WoMLST scores, and WoMLST and euthanasia scores were positively correlated. CONCLUSION: Nurses should be trained to deal with ethical issues that may arise while caring for terminal patients. It is necessary for nurses to understand the concepts related to CoGD, WoMLST, and euthanasia, and to promote bioethics education with focus on decision-making and problem-solving ability in ethically conflicting situations.
Bioethics ; Busan ; Education ; Ethics ; Euthanasia* ; Hospitals, General ; Humans ; Medical Futility ; Seoul

PURPOSE: This study was to identify the meaning of the lived experiences, to describe of the meaning structures and to develop the strategies of nursing intervention centering to these meanings of the smoking cessation. METHOD: This study was derived from a phenomenological analytic method suggested by Giorgi. The participants in this study were five adults who had the previous experience of smoking cessation. The data were collected from September of 2001 to April of 2002 through systemic interviews and participatory observations. Average of five interviews were performed, and each interview lasted an hour and half. RESULT: The meaning of smoking cessation was categorized with nine components. That is (1) obstinacy of the habit of smoking ; difficulty of endurance, succumb to temptation of smoking, repetition of smoking and smoking cessation, habit-forming. (2) Bring about a symptom of improving ; took place headache, expectoration of sputum, sense of instability. (3) Waver in worthy ; doubts about smoking cessation, ridiculed smoking cessation. (4) Be narrowed social life ; become estranged from friends. (5) Futility ; unnecessary, harm. (6) Self-repression ; occurred indomitable mind, strong will, endurance. (7) Gratification ; self-admiration, receive praise from family. (8) Delightfulness ; clean in body and clothes, be disgusted with the foul order of smoking. (9) Improvement in welfare ; a clear mind and good memory, improve in health, have a good appetite. CONCLUSION: The nursing intervention must be focused on these concerns to accomplish successful smoking cessation program.
Adult ; Appetite ; Friends ; Headache ; Humans ; Medical Futility ; Memory ; Nursing ; Smoke* ; Smoking Cessation* ; Smoking* ; Sputum

There are more than 65,000 cancer deaths per year in Korea. To what extent should we continue aggressive treatment in terminal patients? In the course of clinical care of a critically ill patient it may become clear that the patient is inevitably dying, the goal of medical treatment should not be to prolong the dying process without benefit to the patient or to others. Further intervention which will do no more than prolong the active dying process is often described as "futile." Even though hospice is widely accepted in Korea, there is still controversy about withholding or withdrawing life-sustaining treatment. Conflicts between the parties may interrupt satisfactory decision-making and adversely affect patient care, family satisfaction, and physicianclinical team functioning. When further intervention to prolong the life of a patient becomes futile, physicians have an obligation to shift the intent of care toward comfort and closure. However, there are necessary value judgments involved in coming to the assessment of futility. In this context, Korean society needs consensus agreement on futility issue, based on our own social values.
Consensus ; Critical Illness ; Hospices ; Humans ; Judgment ; Korea ; Medical Futility ; Patient Care

It is not the best way to treat a hopeless patient with life-sustaining medical devices until the heart beats stop. Advanced medical technology may prolong the life for a significant period without recovery from the disease. However, it would give an unbearable economic burden to the family and the society. In 2006, we decided not to operate 9 patients with traumatic intracranial hematomas. We examined those patients with special references to possible legal and ethical problems. It is reasonable to withhold a treatment after documentation that the family never wants any life sustaining treatment when the treatment does not guarantee the meaningful life.
Craniocerebral Trauma* ; Decision Making ; Head* ; Heart ; Humans ; Intracranial Hemorrhage, Traumatic ; Medical Futility ; Resuscitation Orders ; Withholding Treatment

BACKGROUND: We constructed a prospective study to evaluate the outcome of patients referred to an intensivist for ICU admission as well as the factors associated with ICU admission refusal. METHODS: Patients referred for ICU admission to medico-surgical ICU in our hospital for 16 weeks were included in this study. We classified the reasons for refusal into three categories: inappropriate referral; triage; futility. Also we classified admitted patients into two categories: immediate admission; delayed admission. After initial evaluation of a patient by an intensivist, we checked the patient's outcome for following 28 days. RESULTS: 632 patients had been referred for ICU admission during study period. Among them, 445 (70%) patients were admitted and 187 (30%) patients were refused ICU admission. 116 patients were refused because of inappropriate referral, 52 for triage and 19 for futility. 394 patients were admitted immediately and 51 were refused initially but were later admitted. When 116 inappropriate referral patients were excluded, the mortality rates for immediate admission, delayed admission and triage/futility were 14.4%, 39.2% and 56.3%, respectively (P<0.05). Standardized mortality ratio was 0.70 for immediate admission, 1.20 for delayed admission, 1.28 for triage and 1.30 for futility (P<0.05). The factors associated with refusal for ICU admission were age, medical division, diagnostic group and high Mortality Probability Model II0 (MPM II0) grades. CONCLUSIONS: Because the triage decision for ICU admission influences the patients' outcome, an intensivist must carefully come to a decision when admitting patients to ICU by considering the appropriate guidelines for ICU admission and triage.
Disulfiram ; Humans ; Intensive Care Units ; Medical Futility ; Mortality ; Prospective Studies ; Referral and Consultation ; Triage*