Futility

Abstract

"This story concerns a patient, a youngish man who has a diagnosis of ALS (or Lou Gehrig’s disease.) ALS is fatal, the only real unknown is how long it will take for the patient to die. Th e patient was a part of a large ALS treatment programme at a major Canadian centre. This centre’s ALS treatment programme had a policy (or perhaps a practice) of not offering ventilator support to ALS patients at the end stages of the disease. (Ventilator support would be offered in the earlier stages of the disease with the expectation that the patient would be weaned from the ventilator. Terminal ventilation was not offered.) Well, you can imagine what happened. The patient reached the end stages of the disease and requested (demanded) that he be put on a ventilator. The team refused, “it is against our policy” (practice), they said. At this stage we held an ethics case consultation, which was attended by most of the staff of the ALS programme and many representatives of the ICU. We are not going to offer a ventilator, said the head of the ALS treatment programme, “no” agreed the head of the ICU, “It’s futile.” [...]", p. 1