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

The Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life came into effect on February 4th, 2018, in South Korea. Based on the Act, all Koreans over the age of 19 years can decide whether to refuse life-sustaining treatments at the end of life via advance directive or physician orders. Hemodialysis is one of the options designated in the Act as a life-sustaining treatment that can be withheld or withdrawn near death. However, hemodialysis has unique features. So, it is not easy to determine the best candidates for withholding/withdrawing hemodialysis at the end of life. Thus, it is necessary to investigate the meaning and implications of hemodialysis at the end of life with ethical consideration of futility and withholding or withdrawal of intervention.
Advance Directives ; Hospices ; Humans ; Korea ; Medical Futility ; Palliative Care ; Renal Dialysis* ; Terminal Care

The increased understanding of the molecular pathology of different malignancies, especially lung cancer, has directed investigational efforts to center on the identification of different molecular targets and on the development of targeted therapies against these targets. A good representative is the epidermal growth factor receptor (EGFR); a major driver of non-small cell lung cancer tumorigenesis. Today, tumor growth inhibition is possible after treating lung tumors expressing somatic mutations of the EGFR gene with tyrosine kinase inhibitors (TKI). This opened the doors to biomarker-directed precision or personalized treatments for lung cancer patients. The success of these targeted anticancer therapies depends in part on being able to identify biomarkers and their patho-molecular make-up in order to select patients that could respond to specific therapeutic agents. While the identification of reliable biomarkers is crucial to predict response to treatment before it begins, it is also essential to be able to monitor treatment early during therapy to avoid the toxicity and morbidity of futile treatment in non-responding patients. In this context, we share our perspective on the role of PET imagingbased phenotyping in the personalized care of lung cancer patients to non-invasively direct and monitor the treatment efficacy of TKIs in clinical practice.
Biomarkers ; Carcinogenesis ; Carcinoma, Non-Small-Cell Lung ; Erlotinib Hydrochloride ; Genes, erbB-1 ; Humans ; Lung ; Lung Neoplasms ; Medical Futility ; Molecular Targeted Therapy ; Pathology, Molecular ; Positron-Emission Tomography ; Protein-Tyrosine Kinases ; Receptor, Epidermal Growth Factor ; Treatment Outcome ; Tyrosine

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

For patients who are near the end of life, an inevitable step is discussion of a do-not-resuscitate (DNR) order, which involves patients, their family members and physicians. To discuss DNR orders, patients and family members should know the meaning of the order and cardiopulmonary resuscitation (CPR) which includes chest compression, defibrillation, medication to restart the heart, artificial ventilation, and tube insertion in the respiratory tract. And the following issues should be considered as well: patients' and their families' autonomy, futility of treatment, and the right for death with dignity. Terminal cancer patients should be informed of what futility of treatment is, such as a low survival rate of CPR, unacceptable quality of life after CPR, and an irremediable disease status. In Korea, two different law suits related to life supporting treatments had been filed, which in turn raised public interest in death with dignity. Since the 1980s, knowledge of and attitude toward DNR among physicians and the public have been improved. However, most patients are still alienated from the decision making process, and the decision is often made less than a week before death. Thus, the DNR discussion process should be improved. Early palliative care should be adopted more widely.
Cardiopulmonary Resuscitation ; Decision Making ; Emigrants and Immigrants ; Heart, Artificial ; Humans ; Jurisprudence ; Korea ; Medical Futility ; Palliative Care ; Quality of Life ; Respiratory System ; Resuscitation Orders ; Right to Die ; Survival Rate ; Terminal Care ; Thorax ; Ventilation

PURPOSE: The purpose of this study is to evaluate the prescription of essential or futile medications for terminal cancer patients during their final admission. MATERIALS AND METHODS: We conducted a retrospective review of the medical charts of terminally ill cancer patients admitted to the Hemato-oncology Department of two teaching hospitals from March 1, 2007 to December 31, 2009. Essential medications were based on the drugs listed by the International Association for Hospice and Palliative Care, while futile medications were defined when short-term benefit to patients with respect to survival, quality of life, or symptom control was not anticipated. RESULTS: A total of 196 patients were included. Among essential medications, strong opioids were the most frequently prescribed drugs during the last admission (62.2% fentanyl, 44.3% morphine), followed by megestrol (46.0%), and metoclopramide (37.2%); 51% of gastric protectors were prescribed with potential futility. Anti-hypertensive and antiglycemic agents were administered to those who experienced arterial blood pressure below 90 mm Hg (47.3%) or presented with a single measurement of fasting glucose below 50 mg/dL (10.7%), respectively. Statins were prescribed to 6.1% (12/196) of patients, and 75% of those prescriptions were regarded as futile. CONCLUSION: Our data suggest that effective prescription of essential medications and withdrawal from futile medications should be actively reconciled for improvement of a patient's end-of-life care.
Analgesics, Opioid ; Arterial Pressure ; Fasting ; Fentanyl ; Glucose ; Hospices ; Hospitals, Teaching ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Medical Futility ; Megestrol ; Metoclopramide ; Palliative Care ; Prescriptions ; Quality of Life ; Retrospective Studies ; Terminally Ill

Hospice palliative care does not aim at the artificial prolongation or artificial hastening of human lives. It helps terminal patients to face the natural end of their lives comfortably, by controlling the suffering of the patients and family members. Hospice in Korea was started in 1965 by Roman Catholic sisters from Australia without successive development, but it has been actively developed since the 1990s. Nevertheless, many tasks remain to be addressed before reasonable and sufficient palliative care can be provided to provide a high quality of life for terminal patients. Laws and regulations for hospice and palliative care should be established and reimbursement from the National Medical Insurance for palliative care also needs to be initiated. In addition, efforts should be made for the education of specialists and lay people to increase the acceptance of hospice and palliative care in Korean society. Ethical issues involved in terminal care, such as the withdrawal of futile treatment and use of advance medical treatment, should be widely discussed within Korean society until a broad consensus is reached.
Australia ; Catholicism ; Consensus ; Hospices ; Humans ; Insurance ; Jurisprudence ; Korea ; Medical Futility ; Palliative Care ; Quality of Life ; Siblings ; Social Control, Formal ; Specialization ; Stress, Psychological ; Terminal Care

The development of life sustaining treatment technology including artificial ventilation has given us the moral problem, considering the human dignity and futility of medical treatment, until when these treatments could be given to terminally ill patients. In Korea, there were two supreme court decisions a significant impacts on the withdrawal of life sustaining treatment. After these decisions, Korean medical society has developed a guideline for advance directives and has also established a voluntary hospital ethics committee. The patient's right of self- determination right and the paternalistic approach of medicine should be balanced at an optimal level, because benefits of medical advances should be adjusted to take into account the burden of life prolongations. Decision making always has been difficult because related to ethical values, and there a broad spectrum of value-laden attitudes within Korean society. The legalization of end-of-life care should be from the respect of the professional autonomy of medical society. Under these considerations, we should supply alternative methods like hospice care, which can help to manage the withdrawal of life support appropriately, and also make an effort to relieve the economical burden of patients.
Advance Directives ; Decision Making ; Ethics Committees ; Ethics Committees, Clinical ; Hospice Care ; Hospices ; Hospitals, Voluntary ; Humans ; Jurisprudence ; Korea ; Medical Futility ; Patient Rights ; Personal Autonomy ; Personhood ; Professional Autonomy ; Societies, Medical ; Supreme Court Decisions ; Terminally Ill ; Ventilation ; Withholding Treatment

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

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