Non-Beneficial ('Futile') Emergency Medical Interventions
Reaffirmed October 2008 by the ACEP Board of Directors
Reaffirmed by the ACEP Board of Directors October 2002
Approved by the ACEP Board of Directors March 1998
The American College of Emergency Physicians (ACEP) believes that emergency physicians and other emergency health care professionals have a duty to provide appropriate evaluation and treatment for every patient who presents to the emergency department. Emergency physicians make patient-centered treatment decisions based on information from available sources, including medical history, physical examination, diagnostic tests, and the patient's wishes, as expressed verbally or by means of advance directives.
Emergency physicians may encounter situations, commonly near the end of life, in which a patient or surrogate requests treatments that, in the physician's judgment, have no realistic likelihood of providing medical benefit to the patient. Regarding such treatments deemed nonbeneficial, ACEP believes:
Physicians are under no ethical obligation to render treatments that they judge have no realistic likelihood of medical benefit to the patient.
Emergency physicians' judgments in these matters should be unbiased, and should be based on available scientific evidence, and societal and professional standards.
Decisions about providing or forgoing nonbeneficial treatment are commonly made near the end of life. Emergency Physicians regularly encounter patients in cardiac arrest who have no realistic likelihood of survival. In such circumstances, emergency physicians should consider withholding or discontinuing resuscitative efforts, in both the prehospital and hospital settings.
When making decisions regarding resuscitation, emergency physicians should be sensitive to differences of opinion among physicians, patients, and families regarding the value of medical intervention in various situations.
Additional information that becomes available may necessitate alteration of previous clinical decisions.
When emergency physicians decide to forgo nonbeneficial treatments, especially in the dying patient, special efforts should be made to maintain communication and to provide comfort, support, and counseling for the patient, family, and friends.