Normative analysis and ethical evaluation of medical decisions made in intensive care unit at the end of life in the context of futility

The development of intensive care medicine with technological opportunities and the spread of intensive care services have raised the question of how to allocate the limited intensive care resources. In this context, it is also discussed how to decide to withhold or withdraw treatment due to medical futility. The aim of this doctoral study is primarily to determine how intensive care physicians in Turkey make decisions in the context of futility at the end of life and following to develop solutions for how decisions should be made. In line with this purpose, a mixed method, which is based on the use of both empirical and normative methods, was used in the research. In the empirical part was used grounded theory, one of the qualitative analysis methods, and in-depth interviews were conducted with eleven intensive care physicians. The data obtained were analyzed using the MAXQDA 2022 Analytics Pro program and five themes were achieved: intensive care, futile treatment, ethical issues, Covid-19 pandemic, and decision making. Grounded theory analysis revealed that physicians make decisions on futile treatment based on medical consensus without standardized consultation, under legal or social pressure, with limited resources, sometimes in conflict of interest, and based on their conscience or personal preferences. In line with the medical consensus, the normative concepts of benefit, age, justice, and conscience affect the decision-making processes as a team. As a result of the normative analysis, it was concluded that making a conscientious decision as a team at the end of life, in line with medical knowledge, is not sufficient for the correct management of the process. The conscience, which is a relative and ambiguous concept that varies according to the person, does not have a function to provide ethical legitimacy since it does not have a normative power. Therefore, ethical analysis and rational evaluations should be made in decision-making processes, clinical ethics guidelines should be used, and consultancy should be obtained from hospital ethics committees when necessary.