The article outlines a nine-step process adopted at The University of Texas M D Anderson Cancer Center for handling patient requests for medically inappropriate interventions. The main step in the process is review by an Institutional Review Committee composed of the physician-in-chief, ethics committee members, and medical experts. The decision of the Review Committee is binding. The experience with this “futility” policy is discussed including a follow-up pilot project conducted by the Department of Gynaecologic Oncology that introduces a standardized advance care planning medical record progress note in which patient preferences about cardiopulmonary resuscitation, mechanical ventilation, and location of death are documented. The note is to be used at the beginning of non-curative therapy and is intended to help to avoid future requests for futile interventions.
Although great strides have been made in treating cancers, a significant number of patients still reach the point at which no curative treatment is available. Physicians then face the difficult task of informing patients that, although palliation is always possible, cure is not.
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