The Futility of Futility: Death Causation is the ‘Elephant in the Room’ in Discussions about Limitation of Medical Treatment
- Michael A. Ashby
- … show all 1 hide
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
The term “futility” has been widely used in medical ethics and clinical medicine for more than twenty years now. At first glance it appears to offer a clear-cut categorical characterisation of medical treatments at the end of life, and an apparently objective way of making decisions that are seen to be emotionally painful for those close to the patient, and ethically, and also potentially legally hazardous for clinicians. It also appears to deal with causation, because omission of a futile treatment cannot surely be a cause of death. The problem is that futility can be argued to be a “false friend”, in that it gives an appearance of representing a reliable conceptual basis, in ethics, for limitation of medical treatment—usually in the context of dying—without actually doing so. In fact, the concept of futility is a conflation of clinical judgement about outcomes of treatment and the quality or even value of life, and has really failed to contribute much to the advancement of decision-making and hence care at the end-of-life. It also has the capacity to medicalise the personal space. Deliberations about the likely outcomes of medical treatment are necessary, and medical expertise is pivotal. However, futility is argued to have a better future in partnership with a broad social action agenda about the process of dying, such as that articulated in health promoting palliative care, as a basis for better “death-ways” in the 21st century (Kellehear 2005). Medicine needs to more honest and upfront about its limits, as death is, after all, the elephant in everybody's room.
- Ashby, M.A. 2001. Natural causes? Palliative care and death causation in public policy and the law [MD Thesis]. Adelaide: University of Adelaide.
- Ashby, M. 2009. The dying human: a view from palliative medicine. In The study of dying, ed. A. Kellehear. Cambridge: Cambridge University Press.
- Ashby, M., A. Kellehear, and B.F. Stoffell. 2005. Resolving conflict in end-of-life care. Medical Journal of Australia 183(5): 230–231.
- Callahan D (ed). 1996. The goals of medicine. Setting new priorities. Hastings Center Report 26(6): S1-27. Special supplement, November-December.
- Capron, A. 1994. Medical futility: Strike two. The Hastings Center Report 24(5): 42–43. CrossRef
- Detering, K.M., A.D. Hancock, M.C. Reade, and W. Silvester. 2010. The impact of advance care planning on end of life care in elderly patients: Randomised controlled trial. British Medical Journal 340: 1345–1354. CrossRef
- Jalland, P. 2006. Changing ways of death in twentieth century Australia. Sydney: UNSW Press.
- Kellehear, A. 1999. Health promoting palliative care. Melbourne: Oxford University Press.
- Kellehear, A. 2005. Compassionate cities: Public health and end-of-life care. London: Routledge.
- Kellehear, A. (ed.). 2007. A social history of dying. Cambridge: Cambridge University Press.
- Lynn, J., and D.M. Adamson. 2003. Living well at the end of life; adapting health care to serious chronic illness in old age. Arlington: Rand Health.
- 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(6): 369–372. CrossRef
- Schneiderman, L., and N. Jecker. 1995. Wrong medicine. Baltimore: Johns Hopkins University Press.
- Tonelli, M. 2007. What medical futility means to clinicians. HEC Forum 19(1): 83–93. CrossRef
- The Futility of Futility: Death Causation is the ‘Elephant in the Room’ in Discussions about Limitation of Medical Treatment
Journal of Bioethical Inquiry
Volume 8, Issue 2 , pp 151-154
- Cover Date
- Print ISSN
- Online ISSN
- Springer Netherlands
- Additional Links
- End of life
- Palliative care
- Medical decision-making
- Industry Sectors
- Michael A. Ashby (1)
- Author Affiliations
- 1. Palliative Care and Persistent Pain Services, Royal Hobart Hospital, Southern Tasmania Area Health Service and School of Medicine, Faculty of Health Sciences, University of Tasmania, 1st Floor, Peacock Building, Repatriation Centre, 90 Davey St, Hobart, Tasmania, 7000, Australia