The majority of futility of care cases that cause ethical trepidation involve interpersonal
conflict. Sometimes, as the moral distress literature attests, the conflict might be among
the health professionals themselves, who keenly disagree about the nature or scope of care
a patient should receive. More often, conflicts involving futility of care occur between
health professionals and family members. Health professionals typically have trouble
understanding why family members cannot accept the “clinical reality” of their loved
one’s situation, while family members might distrust health professionals or interpret
their loved one’s situation with an entirely different cognitive schema. What is often seen
in these scenarios is a remarkable array of disagreements about what is actually going on,
what facts and values are really important, and what should be done.
This presentation will explore strategies that might diminish factors precipitating such
conflicts in the hope that professionals and family members might reach agreement about
a program of care more rapidly and amicably. After examining the psychological and
narrative architecture of futility cases, the presentation will offer ideas on getting clinical
relationships off to a good start, managing excessively demanding or angry family
members and exploring a host of empathic strategies that can preserve the therapeutic
dimensions of a professional‐family relationship, even when the parties disagree.
Dr. John Banja is a professor in the Department of Rehabilitation Medicine and a medical
ethicist at the Center for Ethics at Emory University.