Medical Indications

Consider each medical condition and its proposed treatment. Ask the following questions:

• Does it fulfill any of the goals of medicine?
• With what likelihood?
• If not, is the proposed treatment futile?

Patient Preferences

Address the following:

• What does the patient want?
• Does the patient have the capacity to decide? If not, who will decide for the patient?
• Do the patient's wishes reflect a process that is
  • informed?
  • understood?
  • voluntary?

Quality of Life

Describe the Patient's quality of life in the patient's terms.

• What is the patient's subjective acceptance of likely quality of life?
• What are the views of the care providers about the quality of life?
• Is quality of life "less than minimal?" (i.e., qualitative futility)

Contextual Features

Social, legal, economic, and institutional circumstances in the case that can:

• influence the decision
• be influenced by the decision

e.g., inability to pay for treatment; inadequate social support