The Medical Care That Helps No One

Early in my career as an ICU nurse, a chatty resident and I were working together at the bedside of a profoundly ill patient. The resident asked me how I liked my job. Looking at the young man in front of us, I told him that I’d been surprised to learn how much we did for patients we knew were not going to get better. A fungal infection had caused large abscesses in this patient’s brain, surgery hadn’t healed him, and numerous signs—his unstable vitals, his extremely poor neuro exam—indicated that if it was unlikely he would survive, it was obvious he would never wake up. His swelling brain was putting pressure on his optic nerve, causing his pupils to dilate and raising the threat of herniation, in which the brain is squeezed through the hole at the bottom of the skull. Days ago he had been impossible to sedate; now he required no sedation, passively receiving breaths from the ventilator. “Oh yeah,” the resident said with a shrug. “It’s crazy.”

Americans openly discuss many problems in health care, such as out-of-control costs, greedy insurance companies, and understaffing. But not so much futile care, which is generally defined as an intervention that does not benefit the patient. It is a subjective term, but concerns about “medically futile” treatment “at end-of-life have risen over the past decade,” according to a 2022 review in . In reported that 11 percent of patients received futile treatment, and another 8.6 percent