From "Longshot" to "Fantasy": Obligations to Pediatric Patients and Families When Last-Ditch Medical Efforts Fail.

Publisher: Taylor & Francis Country of Publication: United States NLM ID: 100898738 Publication Model: Print Cited Medium: Internet ISSN: 1536-0075 (Electronic) Linking ISSN: 15265161 NLM ISO Abbreviation: Am J Bioeth Subsets: MEDLINE

Publication: <2008- > : Philadelphia, Pa. : Taylor & Francis
Original Publication: Cambridge, Mass. : MIT Press, c2001-

Communication* ; Critical Care* ; Life Support Care* ; Treatment Failure*; Professional-Family Relations/*ethics; Female ; Humans ; Infant ; Male

Clinicians at quaternary centers see part of their mission as providing hope when others cannot. They tend to see sicker patients with more complex disease processes. Part of this mission is offering longshot treatment modalities that are unlikely to achieve their stated goal, but conceivably could. When patients embark on such a treatment plan, it may fail. Often treatment toward an initial goal continues beyond the point at which such a goal is feasible. We explore the progression of care from longshot to fantasy using two pediatric cases. This progression may be differentiated into four distinct stages of care related to the potential of achieving the initial goals of care. Physicians are often ill prepared for the progression of treatments from a longshot hope to an unfeasible and, therefore, typically unjustified intervention. We present a structured approach to guide clinicians at referral institutions where these situations may be common. The transition of care from "longshot" to "fantasy" is an inherent part of quaternary care for the sickest of patients that has been underexplored. Physicians are often poorly equipped to approach that transition. We advocate this approach to the shift from longshot to fantasy with the belief that such a structured method will have multiple benefits, including: reduced suffering for the patient; decreased emotional burden on patient and family; decreased provider moral distress; increased likelihood of seeking high quality palliative care earlier; and provision of honest and straightforward information to patients and their families.

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Comment in: Am J Bioeth. 2018 Apr;18(4):W4-W7. (PMID: 29621449)
Comment in: Am J Bioeth. 2018 Apr;18(4):W8-W9. (PMID: 29621465)

Keywords: futility; hope; intensive care; pediatrics

Date Created: 20180110 Date Completed: 20190529 Latest Revision: 20190529

20221213

10.1080/15265161.2017.1401157

29313768