Medical futility and offering or withholding non beneficial interventions in “red light” states

This post is geared toward intensivists in red-light states in the US, meaning physicians cannot withhold “life sustaining treatments” without patient or surrogate consent.

Generally this is meant to include CPR and mechanical ventilation, but the legal language varies by state and overall is vague.

Fundamentally if a patient comes to you with severe comorbidities (ie metastatic cancer with life expectancy <3 months) and/or is acutely unwell with an unsurvivable condition (ie coded multiple times on 3 pressors, major liver and kidney failure, lactate 10+), what items off the menu are you either offering, informing family you are not offering, or just straight up not even discussing? This would include emergent exploratory surgery, CRRT, ECMO, etc.

For arguments sake we can assume the family “wants everything” and you can‘t cop out and phone a friend (ethics, palliative, etc).

The basis for this question is that it seems a lot of non-beneficial treatments are either offered to families, or discouraged but still done if families “insist”. Intensivists in red-light states often seem to not feel empowered to definitively say certain treatments are non-beneficial in this case.