Episode 277: Futility in Care: How to Advocate for Your Patients and Prevent Ethical Distress

"One of the things about futility is many people will say, 'Oh this is futile care,' when what they really mean is, 'Who in their right mind would want this?' or 'I would never ever want this,' and that's different. That's not futile care. That's potentially inappropriate care. And sometimes that's the big step for folks," Lucia D. Wocial, PhD, RN, FAAN, HEC-C, senior clinical ethicist in the John J. Lynch Center for Ethics at the MedStar Washington Hospital Center in Washington, DC, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about futile care: how to recognize it, how to approach communication during difficult situations, and how to address a nurse's associated ethical distress. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below. Music Credit: " Fireflies and Stardust " by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: The learner will report an increase in knowledge related to futility in care and how to speak up for patients and prevent ethical distress. Episode Notes The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities . Wocial's Moral Distress Thermometer for Nurses Oncology Nursing Podcast: Episode 222: Ethical and Moral Dilemmas of Futility in Cancer Care and Treatment Episode 78: Ethical Distress Impacts Nursing Practice ONS Voice articles: Moral Injury and Trauma in Nursing Four R's and Resilience Approach Help Oncology Nurses Respond to Morally Distressing Challenges Sort Through Ethical Dilemmas in Medically Futile Care When Do You Stop Fighting? Clinical Journal of Oncology Nursing articles: The Ethical Dilemma of Medical Futility: The Case of Mr. X Understanding the Moral Distress of Nurses Witnessing Medically Futile Care When Does Treatment in Cancer Care Become Futile? American Association of Critical Care Nurses moral distress resources American Nurses Association moral distress toolkit End-of-Life Nursing Education Consortium (ELNEC) To discuss the information in this episode with other oncology nurses, visit the ONS Communities . To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library . To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org . Highlights From Today's Episode "It's a term that appeared in the literature back in the 1980s when it became clear that we had medical technology that could sustain people's lives but not actually return them to a healthy state. And so, there was this attempt to try and identify and define when it was that the care we were providing, the treatments we were providing, could no longer work. And so, some people tried 'qualitative futilities,' some people tried 'quantitative futility.' People have been working on it for a long time, but the shortest definition is a treatment intervention that will not have its intended effect." TS 1:52 "And first of all, it says futility is a definition that should be used sparingly. There are lots of times when a treatment may be considered what we call 'potentially inappropriate.' And when thinking about what's the difference between futility and potentially inappropriate? Futility is, it's clearly not going to work. Potentially inappropriate is, well, it might work, but there are lots of competing reasons why maybe we ought not to do it. And some of those reasons might be significant burden. Some of them may be the patient won't be able to achieve a neurologic state where they be able to actually perceive the benefit of ongoing biological existence. That statement, it has some very clear recommendations about: be very careful about how you use the words." TS 7:15 "In my work as a clinical ethicist, far and away the more frequent reason we get called is families want to keep going. It's not the other way around. And in fact, when a family or a patient is ready to stop, those become incredibly difficult for the healthcare team, particularly when there's a physician who feels like, 'But I know this will work. Don't not do this. You have a 50%, 60%, 70% chance of surviving. don't you want to try?' So to know that you have the ability to give them a chance is one thing." TS 13:33 "And here's the tragedy in this, and I hear oncologists say this, 'Well, it's not time yet.' That's my favorite response, it's, 'Not yet. Not yet.' So, when you ask most people, 'If you knew that you were going to die in the next three months, are there things that you would want to do before you die?' most people are like, 'Well yeah'. To fail to invite this conversation robs them of this choice." TS 16:04 "Step one: Don't keep it to yourself. A lot of it is making sure that you talk with other folks, and if you work in an inpatient setting and your hospital is Joint Commission certified, then there is some mechanism in place in your institution for dealing with an ethics challenge. But the idea is what we do is hard. And one of the biggest challenges for people who are experiencing ethics distress or moral distress is very rarely do ethical challenges happen when people are having a good time. There's a tragedy somewhere, and part of the big challenge is to separate the tragedy, like the cosmic unfairness, injustice, from 'Are we as a healthcare team contributing to the injustice?'" TS 40:51