Developing the language of futility in psychiatry with care

In psychiatric practice, treatment success is, in many instances, not an achievable goal. Psychiatrists may often not acknowledge treatment failure in their patients and seldom consider that patients may be in situations that share similarities with end-of-life dilemmas in general somatic medicine. In such instances, futile treatment may be continued and patient suffering may be prolonged. Doctors should play a leading role in patient education, diagnosis, promoting best treatment options, motivation and support, but patients should be given the opportunity to take ownership of their illness and their future. In the discipline of psychiatry, physician-assisted suicide may be an option but warrants careful consideration. Contemporary psychiatrists may act paternalistically, refusing to accept the limitations of their scientific skills and/or struggle with the moral good of ‘letting go’ when required. It is arguably the seeming complexity of gauging patients’ understanding (competency, capacity) to make informed decisions that perpetuates futile treatment. Most patients, even in the presence of ongoing serious psychiatric illness, are able to give consent. Psychiatrists should be aware of the difference between being alive and living. Ongoing suffering cannot be condoned. The personhood of every patient and his/her bio-psycho-social and spiritual needs should, as far as possible, be respected. Psychiatrists should embrace the realisation of treatment futility and, in some cases, end-of-life decisions and take on the challenge as well as the responsibility of serving patients with mental illness in the best way possible.