Futility: not just a medical issue

Article Abstract:

Futility of treatment is not a medical issue, but involves moral, political and economic concerns. Dr Kathryn Koch and colleagues are mistaken in their argument that recognition of futility would restore decision-making power to physicians. Patient participation can enhance the doctor-patient relationship, whereas difficult patients would be the same under any system. Furthermore, physician judgments concerning futility should not take the place of social decisions concerning allocation of medical resources, as suggested by Dr Steven Miles. Standards of futility should be guided by shared social values rather than treated as purely technical medical issues.

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Futility: a concept in search of a definition

Article Abstract:

The concept of 'futility' is being used by physicians to put in medical terms difficult ethical decisions about termination of medical care. Beyond a narrow physiological meaning, futility is used to describe judgments of the likelihood of achieving therapeutic goals of improving the patient's quality or duration of life, potential of harm to the patient or of survival with severe disabilities, and allocation of scarce medical resources. Many of these issues should be decided by society rather than by individual physicians. However, the right to refuse treatment does not entail the right to insist on treatment.

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Medical futility

Article Abstract:

The concept of medical futility may be viewed as a logical ideal, as a professional duty, or as an institution. Problems with defining the concept logically suggest that it is not certain but probabilistic and socially defined. As a professional duty, futility would need consensus from physicians, perhaps through professional association standards. The institutional approach views futility as a way of dealing with tragic choices concerning treatments for which the outlook is poor. It offers a needed counterweight to patient autonomy in cases involving the least successful treatments.

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