Sophia Bröchtel¹, Andre Nowak², Theresa Schneider³

¹ Clinical Ethics Committee, University Medical Centre Göttingen and Academy for Ethics in Medicine e.V.

2 Clinical Ethics Committee and Clinical Ethics, University Medical Centre Schleswig-Holstein, Kiel/Lübeck

3 Institute of History and Ethics of Medicine, Centre of Excellence in Health Sciences, School of Medicine, Martin Luther University, Halle (Saale)

General information:

Duration: 150 mins (2.5 hours)
Group size: max. 20 people
Target audience: Healthcare professionals, ethics advisers
Topic: Futility

Brief description: Life is a precious commodity, as it is limited for all people. In many cases, life expectancy can be extended through a healthy diet, exercise and avoiding risky activities. However, medical progress is also ensuring that average life expectancy continues to rise. With high-tech surgery, chemotherapy, heart-lung machines and similar treatments, modern medicine ensures that death occurs much later than it did 100 years ago.

In many situations, this development is seen as a blessing, and many patients have benefited from ever-improving and new treatment options. However, this also raises the question, with increasing frequency, of how far medicine should or is allowed to go. In practice, conflicts arise within the team or between the team and relatives when there are differing views on the treatment goal and the medical indication. Questions such as these arise: When is treatment still indicated, and when is it futile to provide curative treatment or to keep patients alive? Is mere life-sustaining treatment a therapeutic goal? How should one proceed in the event of a disagreement?

Over the course of the workshop, participants’ understanding of ‘futility’ (pointlessness/uselessness) will be expanded and analysed in greater detail and discussed using a case study. This addresses a topic that repeatedly causes unease and/or uncertainty in the day-to-day work of healthcare staff and those providing ethical guidance.

Procedure: Following a brief introduction, group work will begin using the so-called ‘placemat’ method. To do this, four people will sit together at a large sheet of paper to first note down, in their own section, their prior knowledge on the topic of ‘futility’. The group then exchanges ideas and notes down the key insights on this topic in the centre of the sheet. Subsequently, the key points from each group are presented to the whole group, and the information gathered so far is expanded upon by the workshop leader.

The topic of ‘futility’ is illustrated in a practical way through the presentation of a fictional but realistic case study, after which the discussion begins. Participants are divided into three sub-groups to discuss a specific question relating to the case. After 15 minutes of discussion, participants switch groups until everyone has addressed each question. The aim is to analyse the significance of time and the ethical aspects using the specific case as a basis.

• One sub-group focuses on the question of what happens to the individuals concerned during the period of curative treatment. How is the prolongation of life experienced by the patient themselves, by their relatives and by the healthcare team? How do they answer the question of whether the measures are meaningful?
• A second sub-group addresses the question ‘Time = money?’. The aim here is to discuss whether the cost of a bed in an intensive care unit or a shared ventilator ward should play a role in the question of life-prolonging treatment, and why (or why not).
• A third sub-group will examine the risk-benefit balance over time. In the case study, is the harm already so great that treatment is no longer justified? Does the harm increase over time? What benefits does life-prolonging treatment bring to the patient?

Finally, the findings of the sub-groups will be collated in a plenary session and discussed in relation to the potential role of ethical counselling.
The aim of the workshop is to explore and collectively reflect on different perspectives regarding the assessment of the appropriateness of medical interventions.

Satellite workshop timetable (150 mins):

1. Introduction (5 mins)
2. Group work on futility (15 mins)
3. Summary in plenary session, supplemented by the workshop leader (30 mins)
4. Case presentation (5 mins)
5. Case discussion in various small groups (3 x 15 mins)
6. Structured summary in a whole-group session (25 mins)
7. Discussion of the role of ethics consultation in the event of a disagreement (20 mins)
8. Conclusion (5 mins)