Objective: Intensive care units (ICUs) in different parts of the world provide care to patients with advanced age and terminal illness at different rates and in different patterns. In the United States, ICU beds make up a disproportionate number of acute care beds. Nearly half of all patients who die in U.S. hospitals have received ICU, some of which may be futile. The objective of this study was to examine ways in which the delivery of futile care in the ICU can cause harm to patients other than those receiving the futile care.
Design: Review of available studies of patient and family attitudes about cardiopulmonary resuscitation and other supportive modalities, including antibiotic therapy, and the relationship of the delivery of such care to the outcomes of others treated in the ICU.
Patients: Those treated in ICUs and those receiving futile care.
Measurements and main results: Compared with younger patients, the elderly in the United States use more ICU care, at higher cost, have more serious comorbidities, and have a higher mortality rate. Certain populations demand ICU care more than others and often with less benefit than less-demanding populations. In a situation of unlimited resources, the provision of ICU care, even when futile, has been viewed as an individual patient decision with no harm to others within the hospital. However, even with unlimited resources, the use of antibiotics for those who are receiving futile care can be considered unethical by egalitarian theory because it can lead to antibiotic resistance that may make the treatment of other patients impossible. In the setting of limited resources, like in pandemic influenza, or with the potential limiting of resources, in a pay-for-performance environment, the provision of futile care can also harm the hospital population as a whole.
Conclusions: The delivery of futile care is not only an individual patient decision, but must be viewed in a broader context. Societal awareness of this problem is necessary, and better scoring systems to identify when ICU care has limited benefit are needed to address these difficult and challenging realities.