The Attitudes of Patients With Advanced AIDS Toward Use of the Medical Futility Rationale in Decisions to Forgo Mechanical Ventilation

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Abstract
Background: The medical futility rationale asserts that physicians need not offer their patients therapies that have zero or close to zero probability of success. The ratio- nale is controversial, but it is used in practice. Objective: To examine the attitudes of patients with ad- vanced acquired immunodeficiency syndrome (AIDS) to- ward the medical futility rationale as it might apply to their medical care. Methods: We conducted a cross-sectional study with interviewer-administered questionnaires. Fifty-seven pa- tients with advanced AIDS (C3 stage AIDS and a CD4 cell count ,100/µL) were recruited from academic and private clinics. offer mechanical ventilation if the physician judged this intervention to be futile, and 26% (n=15) believed this was probably acceptable. Less than 10% of patients (n=5) said not offering therapy judged futile was definitely not acceptable. Patients who were less likely to prefer me- chanical ventilation in different hypothetical health states were significantly more likely to accept decisions on the basis of futility (P=.003). Health-related quality of life, patient satisfaction with medical care, and patient- clinician communication about end-of-life care were not associated with attitudes toward medical futility. Conclusions: Although the majority of patients with ad- vanced AIDS accept the medical futility rationale, a sub- stantial minority do not. Acceptance of this rationale was associated with wanting less life-sustaining treatment. Phy- sicians invoking the medical futility rationale and hos- pitals using policies incorporating the medical futility ra- tionale should take into account this diversity in the attitudes toward medical futility.

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