When is medical treatment futile?
A guide for students, residents, and physicians
Cite this article as: Kasman, D.L. J GEN INTERN MED (2004) 19: 1053. doi:10.1111/j.1525-1497.2004.40134.x Abstract
A difficult ethical conundrum in clinical medicine is determining when to withdraw or withhold treatments deemed medically futile. These decisions are particularly complex when physicians have less experience with these discussions, when families and providers disagree about benefits from treatment, and when cultural disparities are involved in misunderstandings. This paper elucidates the concept of “medical futility,” demonstrates the application of futility to practical patient care decisions, and suggests means for physicians to negotiate transitions from aggressive treatment to comfort care with patients and their families. Ultimately, respect of persons and beneficient approaches can lead to ethically and morally viable solutions.
Key words medical futility medical education end-of-life care doctor-patient communication medical ethics Download to read the full article text References
Lascaratos J, Poulakou-Rebelakaou E, Marketos S. Abandonment of terminally ill patients in the Byzantine era. An ancient tradition? J Med Ethics. 1999;25:254–8.
The New Lexicon Webster’s Dictionary of the English Language. New York, NY: Lexicon Publications; 1989.
Trotter G, Mediating disputes about medical futility, Camb Q Healthe Ethics. 1999;8:527–37.
Medical futility in end-of-life care: report of the Council of Ethical and Judicial Affairs, JAMA. 1999;281:937–41.
Ardagh M. Futility has no utility in resuscitation medicine. J Med Ethics. 2000;26:396–9.
Schneiderman LJ, Jecker NS, Jonsen AR. Medical futility: its meaning and ethical implications. Ann Intern Med. 1990;112:949–54.
Helft PR, Siegler M, Lantos J. The rise and fall of the futility movement. N Engl J Med. 2000;343:293–6.
McGee DC, Weinacker AB, Raffin TA. The patient’s response to medical futility. Arch Intern Med. 2000;160:1565–6.
Veatch RM, Spicer CM. Medically futile care: the role of the physician in setting limits. Am J Law Med. 1992;18:15–36.
Waisel DB, Truog RD. The cardiopulmonary resuscitation-not-indicated order: futility revisited. Ann Intern Med. 1995;122:304–8.
Kopelman LM. Conceptual and moral disputes about futile and useful treatments. J Med Philos. 1995;20:109–21.
Weijer C, Medical futility. West J Med. 1999;170:254. Editorial.
Pellegrino E. Decisions to withdraw life-sustaining treatment: a moral algorithm. JAMA. 2000;283:1065–7.
Jecker NS, Schneiderman LJ. When families request that “everything possible” be done. J Med Philos. 1995;20:145–63.
Quill TE, Brody H. Physician recommendations and patient autonomy: finding a balance between physician power and patient choice. Ann Intern Med. 1996;125:763–9.
Andre J. Humility reconsidered. In: Rubin S, Zoloft L, eds. Margin of Error: The Ethics of Mistakes in the Practice of Medicine. Hagerstown, MD: University Publishing Group; 2000.
Blustein J. Doing what the patient orders: maintaining integrity in the doctor-patient relationship. Bioethics. 1993;7:290–314.
Fadiman A. The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. New York: Farrar, Straus, and Giroux; 1997.
Franklin C. Allowing patients to decide. Camb Q Health Ethics. 1993;2:205–11.
Pellegrino ED. Patient and physician autonomy: conflicting rights and obligations in the physician-patient relationship. J Contemp Health Law Policy. 1994;10:47–68.
Christakis NA. Death Foretold: Prophecy and Prognosis in Medical Care. Chicago, Ill: University of Chicago; 1999.
© Society of General Internal Medicine 2004