Medical Futility

Abstract

Medical futility is a concept that has been heavily debated since the late 1980s. It is increasingly invoked in end‐of‐life decision‐making as a way to both describe certain situations and to justify refusing treatment as a response to those situations. As the emphasis on patient autonomy has grown, so have demands for treatment that the medical team thinks are inappropriate because they are insufficiently beneficial. The concept of medical futility addresses these treatment demands. Futility judgments have been categorised as physiologic, quantitative and qualitative depending upon the nature of the claim being made. Despite an ongoing dialogue about the nature of these judgments, there is still widespread disagreement about the appropriate use of the concept as a justification for limiting treatment.

Key Concepts:

  • Medical futility is a concept used both to describe certain treatment and as a justification for refusing certain treatment.

  • There is significant disagreement about exactly what medical futility means, in what situations it should be applied, and what justification it ultimately provides for refusing treatment.

  • Medical futility can usefully be distinguished into physiological, quantitative and qualitative futility.

  • The debate over medical futility can be seen as arising from several factors: the development of modern technology, the rise of patient autonomy as a dominant value in Western medicine, and growing concern with cost control.

  • Medical futility can only be determined relative to particular goals and futility judgments require us to consider what we think the appropriate function and goals of medicine should be.

  • Institutional policies about medical futility generally focus on fair procedures for resolving futility disagreements rather than on a universal definition.

Keywords: end‐of‐life; futile; futility; ethics; decision‐making; autonomy

References

Burns J and Truog R (2007) Futility: A Concept in Evolution. Chest 132(6): 1987–1993.

Griener G (1995) The physician's authority to withhold futile treatment. Journal of Medicine & Philosophy 20(2): 207–224.

Halevy A and Brody H (1996) A multi‐institution collaborative policy on medical futility. Journal of the American Medical Association 276(7): 571–574.

Jecker NS and Schneiderman LJ (1992) Futility and rationing. American Journal of Medicine 92: 189–196.

Moratti S (2009) The development of ‘medical futility’: towards a procedural approach based on the role of the medical profession. Journal of Medical Ethics 35: 369–372.

Pope T (2011) Legal briefing: Futile or non‐beneficial treatment. Journal of Clinical Ethics 22(3): 277–296.

Rhodes R (1998) Futility and the goals of medicine. Journal of Clinical Ethics 9(2): 194–205.

Schneiderman LJ, Jecker N and Jonsen A (1990) Medical futility: its meaning and ethical implications. Annals of Internal Medicine 112: 949–954.

Smith M, Gremillion G, Slomka J et al. (2007) Texas hospitals’ experience with the Texas Advance Directives Act. Critical Care Medicine 35(5): 1271–1276.

Truog R, Brett A and Frader J (1992) The problem with futility. New England Journal of Medicine 326(23): 1560–1564.

Younger S (1988) Who defines futility? Journal of the American Medical Association 260(14): 2094–2095.

Further Reading

Gampel E (2006) Does professional autonomy protect medical futility judgments? Bioethics 20(2): 92–104.

Mohammed S and Peter E (2009) Rituals, death and the moral practice of medical futility. Nursing Ethics 16(3): 292–302.

Prendergast T (1995) Futility and the common cold: how requests for antibiotics can illuminate care at the end of life. Chest 107(3): 836–844.

Rubin SB (1998) When Doctors Say No: The Battleground of Medical Futility. Bloomington, IN: Indiana University Press.

Schneiderman L (2011) Defining medical futility and improving medical care. Bioethical Inquiry 8(2): 123–131.

Schneiderman LJ and Jecker NS (1995) Wrong Medicine: Doctors, Patients, and Futile Treatment. Baltimore, MD: Johns Hopkins University Press.

Veatch R and Mason Spicer C (1992) Medically futile care: the role of the physician in setting limits. American Journal of Law and Medicine 18(1): 15–36.

Zucker MB and Zucker HD (eds) (1997) Medical Futility and the Evaluation of Life‐Sustaining Interventions. Cambridge: Cambridge University Press.

Contact Editor close
Submit a note to the editor about this article by filling in the form below.

* Required Field

How to Cite close
Loeben, Gregory S(Sep 2012) Medical Futility. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0003476.pub2]