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The term futility is subject to interpretation.30 Healthcare professionals may determine futile interventions to be those that carry an absolute impossibility of successful outcome, a low likelihood of return to spontaneous circulation, a low likelihood of survival to discharge from the hospital, or a low likelihood of restoration of meaningful quality of life. Futility can be defined as "any effort to achieve a result that is possible, but that reasoning or experience suggests is highly improbable and that cannot be systematically produced."31 There is no consensus among physicians about the meaning of the term. It is probably more accurate to use terminology such as nonbeneficial, ineffectual, or low likelihood of success when discussing resuscitation with patients or families.
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Many ethicists agree that physicians are not required to provide treatments that they estimate will provide little or no benefit to the patient.32,33 The American Medical Association Council on Ethical and Judicial Affairs stated that CPR may be withheld, even if requested by the patient, "when efforts to resuscitate a patient are judged by the treating physician to be futile."34 Dilemmas regarding nonbeneficial interventions often arise due to inadequate or ineffective communication between the physician, patient, and family. This is of particular concern in emergency medicine, in which previous relationships with patients and family rarely exist and time is often inadequate to establish effective relationships. Thus, initial efforts should be directed to improve communication, education, and joint decision making.
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The American College of Emergency Physicians states that "physicians are under no ethical obligation to render treatments that they judge have no realistic likelihood of medical benefit to the patient" (Table 27-2). Emergency physicians' judgments should be unbiased, based on available scientific evidence, mindful of societal and professional standards, and sensitive to differences of opinion regarding the value of medical intervention in various situations.35
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Ultimately, the decision regarding CPR and its likelihood of benefit to the patient and decisions to provide, limit, or withhold resuscitative efforts are to be made by the emergency physician in the context of well-accepted research results, patient and family wishes, and professional judgment. Individual bias regarding quality of life or other related issues should be avoided. There are many situations in which dying can be accepted as a natural process, even in an emergency setting.