In the latest issue of Health Care Ethics USA [20(1), Winter 2012], Ron Hamel and Michael Panicola contribute "Enhancing Communication and Coordination of Care: A Third Generation Approach to Medical Futility." Hamel is Senior Director of Ethics for the Catholic Health Association. Panicola is Director of Ethics for SSM Health Care in St. Louis.
They trace the history of approaches to futility: (1) definitional, (2) procedural, and (3) surrogate selection. But they found that these approaches were not adequately addressing a significant increase in futility cases at SSM acute care facilities. Futility policies were not followed, because physicians, who "felt as though they had no legal coverage," usually "ended up acquiescing to requests for treatment." Hamel and Panicola describe an approach focused on preventing conflict from arising in the first place, including care conferences automatically triggered for "patients with an ICU length-of-stay of more than five days." Included with the article are seven pages from SSM's "Health Care Guidelines." These are good guidelines. Other facilities should consider incorporating aspects into their own policies.
But the SSM Guidelines have some limitations. First, section I(E) advises physicians to "offer only those treatments that are reasonable and realistic in light of the patient's overall condition." But this seems to ignore the diachronic nature of critical care. Certain interventions might have seemed appropriate at T1. The futility conflict arises weeks or months later after it becomes increasingly obvious that the intervention that, at first, seemed appropriate is no longer indicated. It is precisely this situation that frames the Rasouli case pending before the Supreme Court of Canada.
Second, section II(G2) of the guidelines advises that if agreement cannot be reached, then treatment "could be withdrawn provided there is wide agreement among the attending/primary physician, other caregivers, hospital president, ethics committee, and so on." The family "should be notified" and "given an appropriate time to reconcile with the situation or make alternative plans." But this unilateral action is unlikely to be taken. As Hamel and Panicola observe at the start of their article, a procedural approach does not work without legal cover. Oddly, the policy does not include surrogate selection as a dispute resolution pathway.
They trace the history of approaches to futility: (1) definitional, (2) procedural, and (3) surrogate selection. But they found that these approaches were not adequately addressing a significant increase in futility cases at SSM acute care facilities. Futility policies were not followed, because physicians, who "felt as though they had no legal coverage," usually "ended up acquiescing to requests for treatment." Hamel and Panicola describe an approach focused on preventing conflict from arising in the first place, including care conferences automatically triggered for "patients with an ICU length-of-stay of more than five days." Included with the article are seven pages from SSM's "Health Care Guidelines." These are good guidelines. Other facilities should consider incorporating aspects into their own policies. But the SSM Guidelines have some limitations. First, section I(E) advises physicians to "offer only those treatments that are reasonable and realistic in light of the patient's overall condition." But this seems to ignore the diachronic nature of critical care. Certain interventions might have seemed appropriate at T1. The futility conflict arises weeks or months later after it becomes increasingly obvious that the intervention that, at first, seemed appropriate is no longer indicated. It is precisely this situation that frames the Rasouli case pending before the Supreme Court of Canada.
Second, section II(G2) of the guidelines advises that if agreement cannot be reached, then treatment "could be withdrawn provided there is wide agreement among the attending/primary physician, other caregivers, hospital president, ethics committee, and so on." The family "should be notified" and "given an appropriate time to reconcile with the situation or make alternative plans." But this unilateral action is unlikely to be taken. As Hamel and Panicola observe at the start of their article, a procedural approach does not work without legal cover. Oddly, the policy does not include surrogate selection as a dispute resolution pathway.
don’t update frequently enough too. You just never know when the algos are going to bite. 
done some work in this area with projecting several different outcomes so they can move quickly in whatever direction they need. It is what it is today with intelligence and formulas. One health insurance company United recently hired the former US Assistant Attorney General from Minneapolis as a general counsel so that somewhat signals an area of preparedness on the part of big business here. 
can’t talk to that algorithm and it made decisions and sent out flawed information, matched to the wrong person. If you haven’t figured it out yet, this is why the entire Occupy movement got started as it’s not what you see but it’s rather the intelligence that runs in the background you DON’T see. That’s the problem and issue as we base too much of the economy today on algorithms and making money selling data rather than investing in manufacturing and using more technology there. 
same issues though as what we have used for years and that is being assured of what data you load as it’s still a machine. At the end of 2011 it was also announced that on the west coast that Cedar Sinai was going to explore the system for the same or similar purposes. 