Panda Bear: “If we but charged the families a small fraction of the cost for futile care or, more diabolically, had payment garnished from the patient’s estate upon their death, the families would be looking for the plug, especially in the cases where the ICU serves as an expensive funeral home where families can meet to see the body. If the family ever says, ‘We want to keep Uncle Joe on the ventilator until the rest of the family can fly in from Seattle,’ they should be responsible for the full cost of the additional stay.”
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- Futile care in Canada
- Passing the futile care buck
- Taking a stand against futile care
- Respect for Patients and their Families
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I differ from panda on that one. I don’t have a problem keeping an already intubated (DNR) patient without de-escalation of care for family to arrive. Let’s be honest that is typically within 24 hours. I do have a problem extending the death of a patient in a futile situation on family wishes.
I don’t think they should be charged. This would only legitimize the idea of keeping someone around even though they have no quality of life whatsoever. If the care team does decide it’s medically futile and the prognosis is essentially instant death the moment full care is stopped, we should always just pull the plug and not hedge. On the other hand, if the patient can be wheeled out of the hospital, even if they’re trach’ed and on a vent, and even if they have no cognitive function with no chance of meaninful recovery, then it can be argued that this is palliative care and not completely futile (and they’ll aspirate and die eventually in any case.)
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