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Study: When Medical Care Is Futile

Indu Mani, DVM, DSc, Editor, Clinician's Brief

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veterinarian talking to client with geriatric dog

In the literature

Peterson NW, Boyd JW, Moses L. Medical futility is commonly encountered in small animal clinical practice. J Am Vet Med Assoc. 2022:1-7. doi:10.2460/javma.22.01.0033


FROM THE PAGE...

Futile medical care is treatment that is unlikely to have significant clinical benefit; futility can be qualitative (ie, low-quality benefit) or quantitative (ie, low likelihood of benefit). Although medical futility has been well studied in human medicine, evaluation in veterinary medicine is just beginning. Definitions of futile and nonbeneficial care can be nuanced and subjective. 

This cross-sectional study sought to document clinician perceptions and understanding of medical futility, as well as to determine frequency in small animal practice. An anonymous, 25-question online survey was distributed to members of the American College of Veterinary Emergency and Critical Care and ACVIM (small animal internal medicine and cardiology) with an invitation to share with colleagues. Analysis included 477 clinicians, 93.7% of whom were board-certified in a veterinary specialty. 

Most respondents (99%) reported they believe futile care occurs in veterinary medicine, with 99.2% reporting encountering it in their practice career and 42.4% reporting occurrence >6 times annually. A majority of respondents (69.1%) disagreed or strongly disagreed that futile care is always wrong; 70.9% reported futile care can be an appropriate option. The frequency of futile care reported by this population emphasizes the need for a consensus definition of veterinary medical futility.


...TO YOUR PATIENTS

Key pearls to put into practice:

1

Although this study population included mostly board-certified clinicians, medical futility likely occurs regularly in general practice. Self-reflective practice tools and documentation to identify occurrence can inform profession-wide definitions of medical futility.

2

Clinicians should consider whether the provision of their care could be characterized as futile in specific situations and whether providing or refusing that care results in psychological distress. Support should be sought if distress occurs.

3

Definitions of futile care can be subjective and nuanced, necessitating targeted communication between veterinary staff and pet owners that considers the patient’s best interests.

 

Have you ever administered care you believe was futile? Do you still believe it was necessary, whether for the sake of the pet owner or for another reason?

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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