Recommendations
Recommendation 3
Î There are two less-common situations for which the committee
recommends different management strategies.
• Requests for strictly futile interventions. The term "futile" should only be used in
the rare circumstance that an intervention simply cannot accomplish the intended
physiologic goal. Clinicians should not provide futile interventions and should carefully
explain the rationale for the refusal. If disagreement persists, clinicians should generally
obtain expert consultation to assist in conflict resolution and communication.
• Requests for legally proscribed or legally discretionary treatments. "Legally proscribed"
treatments are those that are prohibited by applicable laws, judicial precedent, or widely
accepted public policies (e.g., organ allocation strategies). "Legally discretionary"
treatments are those for which there are specific laws, judicial precedent, or policies
that give physicians permission to refuse to administer them. In responding to requests
for either legally proscribed or legally discretionary treatments, clinicians should
carefully explain the rationale for treatment refusal and, if there is uncertainty regarding
the interpretation and application of the relevant rule, should generally seek expert
consultation to confirm accurate interpretation of the rule.
Recommendation 4
Î The medical profession should lead public engagement efforts and
advocate for policies and legislation about when life-prolonging
technologies should not be used.
