I find this troubling. While futility policies (and laws) are aimed at enabling providers to avoid providing treatment they deem ethically or professionally inappropriate, those policies and laws always inform the patient/surrogate and allow the opportunity to transfer. The objective is to allow specific providers to decline to provide some treatments, not to altogether prohibit the patient from getting the treatment. The objective is to allow providers to extricate themselves from the administration of interventions.
But Curlin et al.'s study suggests that many physicians' refusals look more like evangelism or proselytism. They never even mention some alternatives (even life-preserving or life-sustaining alternatives). Therefore, these physicians' patients/surrogates do not even know to look for a transfer or to seek review.