Limiting 'Futile' Treatment for Terminal Patients Saves Few Dollars

HANOVER, NH--Results of a multicenter study debunk the view that limiting 'futile' life-sustaining treatments for terminally ill patients will produce significant health-care savings. "Cutting off care through strict 'futility guidelines' will save few dollars and not much suffering," said Joanne Lynn, MD, of Dartmouth-Hitchcock Medical Center.

In this study of more than 4,000 patients, all of whom were hospitalized and in an advanced stage of a serious condition, 115 had been given less than a 1% chance of surviving for 2 months. The total hospital bill for these sickest patients was $8.8 million, and precluding the life-sustaining treatments they received would have saved only $1.2 million (JAGS 42:1202-1207, 1994).

Of these sickest patients, almost 86% died within 5 days of prognosis, and all but one died within 6 months. "For the vast majority of the sickest patients, death occurs within 5 days of the onset of serious illness," she said. "For those not quite so sick, I don't think society is ready to demand that treatment be stopped when we still can't predict precisely who will die and when they will die."

Eliminating futile care for 12 patients would have resulted in nearly 75% of the savings in hospital days. But some of these patients had a very strong desire to try all possible interventions to save their lives. Some of them said they definitely wanted resuscitation, based on their religious beliefs. Others were young people who had complications after organ transplant. "Stopping treatment quickly is hard to justify in these cases," Dr. Lynn said.

She suggested that a better alternative to futility guidelines would be to "ensure that decision-making is informed by the patient's preferences and likely outcomes of care." Health professionals might also provide more support to dying patients and their families, so that they can more readily stop futile treatments.