Intractable Conflict in Pediatric Critical Care: A Case Examination and Analysis of Futility

Abstract

The focus and reliance on a concept can often blind us from the real things that exist that cause a concept to come into being. Futility as a concept has been painstakingly debated in the literature. This study takes a different approach and seeks to discover complexity and dynamics of what happens during the course of the care of a child that leads to intractable conflicts. A single case study method is used. Participant interviews, chart review, and policy review were the sources of data explored. Transcriptions of interviews were inductively and deductively analyzed using Walker’s expressive-collaborative model of morality. The roles, relations, objects, and concepts were critically analyzed through systems theory and critical realism. The results of this study suggest reframing discussions away from definitions of futility and movement towards conceptualizations and dialogues that include the moral community, and relationships between and among clinical and organizational ethics. The study advocates a moral and ethical need for early identification of futility dynamics, continuity in communication, and a perspective about managing polarities and problems versus solving them.