Medical futility and family obstinacy in intensive therapy. When to stop and when to keep going?

There have been several recent publications related to therapeutic obstinacy and futility in the Intensive Care Unit. However, little has been published about "the family obstinacy" in persisting with invasive measures in seriously ill patients, despite the appropriate information provided to them about the patient's poor short-term prognosis. On certain occasions, these critical patients are unable to make decisions on the proposed treatments and, unfortunately, many of them have not previously indicated their preferences in terms of limits to invasive measures (advanced directives). Thus, the patient's relatives are the ones who finally assume this arduous task and, in several occasions, they make decisions that do not correspond with the patient's actual wishes. Palliative medicine is of invaluable help in the difficult goal of improving communication among doctors, patients and patients relatives. Limits to intervention can be difficult and vague, generating multiple problems in the decision-making process. On certain occasions and despite adequate information provided by therapists and palliative care doctors, patients' relatives do not accept professional directives indicating to stop invasive interventions. Understanding futility justification may be relevant to the appropriate resolution of these disputes. In this article, we intend to discuss the subject "futility in Intensive Care Unit" and how to face the seldom addressed "family obstinacy" issue in potentially unrecoverable situations, despite adequate medical information