1 in 5 ICU Patients Get 'Futile' Care

Cheryl Clark, for HealthLeaders Media , September 10, 2013

Wenger says it's unclear whether the finding can be extrapolated to other academic medical centers, or non-teaching community hospitals, whether profit or non-profit.

On one hand, a hospital system like UCLA's "is where a patient comes to get saved when they're about to die, a hospital that does organ transplants, and it may very well be that those same factors contribute to continuing to try hard even after you feel the treatments aren't useful."

In an accompanying invited commentary, Robert Truog, MD and Douglas B. White, MD, of Harvard Medical School's Department of Global Health and Social Medicine, were critical of the UCLA report.

First, they wrote that the assessments were made by "a single physician making a single assessment about futility," with no information on whether other doctors or members of the care team, including family, shared their views that care was futile.

Second, much of the $2.6 million cost represents fixed costs of running an ICU, "that cannot be eliminated unless critical care beds are closed," so the cost estimates "are almost certainly less."

Additionally, they wrote, "there is ongoing debate about the boundaries of acceptable practice near the end of life. Short of brain death, there are no criteria or rules to which clinicians can appeal to justify decisions to refuse life support, at least when those treatments hold even a small chance of achieving the patient's goals."

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