Abstract
Physicians may employ the concept of medical futility to justify a decision not to pursue certain treatments that may be requested or demanded by patients or surrogates. Medical futility means that the proposed therapy should not be performed because available data show that it will not improve the patient’s medical condition. Medical futility remains ethically controversial for several reasons. Some physicians summarily claim a treatment is futile without knowing the relevant outcome data. There is no unanimity regarding the statistical threshold for a treatment to be considered futile. There is often serious disagreement between physicians and families regarding the benefits to the patient of continued treatment. Medical futility has been conceptualized as a power struggle for decisional authority between physicians and patients/surrogates. Medical futility disputes are best avoided by strategies that optimize communication between physicians and surrogates; encourage physicians to provide families with accurate, current, and frequent prognostic estimates; assure that physicians address the emotional needs of the family and try to understand the problem from the family’s perspective; and facilitate excellent palliative care through the course of the illness. Critical care physicians should support the drafting of state laws embracing futility considerations and should assist hospital policy-makers in drafting hospital futility policies that both provide a fair process to settle disputes and embrace an ethic of care.
References
Bernat JL. Ethical aspects of determining and communicating prognosis in critical care. Neurocritical Care 2004;1:107–118.
Bernat JL. Ethical Issues in Neurology, 2nd ed. Butterworth-Heinemann, Boston, 2002, pp. 215–239.
Jecker NS, Schneidermann LJ. Medical futility: the duty not to treat. Cambridge Q Healthcare Ethics 1993;2:151–159.
President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Deciding to Forgo Life-Sustaining Treatment: Ethical, Medical and Legal Issues in Treatment Decisions. U S Government Printing Office, Washington, DC, 1983, p. 219.
American Medical Association Council on Ethical and Judicial Affairs. Guidelines for the appropriate use of do-not-resuscitate orders. JAMA 1991;265:1868–1871.
Truog RD, Brett AS, Frader J. The problem with futility. N Engl J Med 1992;326:1560–1564.
Solomon MZ. How physicians talk about futility: making words mean too many things. J Law Med Ethics 1993;21:231–237.
Lantos JD, Singer PA, Walker RM, et al. The illusion of futility in medical practice. Am J Med 1989;87:81–84.
Frick S, Uehlinger DE, Zuercher Zenklusen RM. Medical futility: predicting outcome in intensive care unit patients by nurses and doctors — a prospective comparative study. Crit Care Med 2003;31:456–461.
Cranford RE, Gostin L. Futility: a concept in search of a definition. Law Med Health Care 1992;20:307–309.
Helft PR, Siegler M, Lantos J. The rise and fall of the futility movement. N Engl J Med 2000;343:293–296.
Schneiderman LJ, Jecker NS, Jonsen AR. Medical futility: its meaning and ethical implications. Ann Intern Med 1990;112:949–954.
Schneiderman LJ, Jecker NS, Jonsen AR. Medical futility: responses to critiques. Ann Intern Med 1996;125:669–674.
Schneiderman LJ, Jecker NS. Wrong Medicine: Doctors, Patients, and Futile Treatments. Johns Hopkins University Press, Baltimore 1995.
Truog RD. Can empirical data establish futility? J Clin Ethics 1992;3:315,316.
Prendergast TJ. Futility and the common cold: how requests for antibiotics can illuminate care at the end of life. Chest 1996;107:836–844.
Alpers A, Lo B. Futility: not just a medical issue. Law Med Health Care 1992;20:327–329.
Loewy EH, Carlson RA. Futility and its wider implications: a concept in need of further examination. Arch Intern Med 1993;153:429–431.
Brody H. The physician’s role in determining futility. J Am Geriatr Soc 1994;42:875–878.
Veatch RM. Why physicians cannot determine if care is futile. J Am Geriatr Soc 1994;42:871–874.
Miles SH. Informed demand for “non-beneficial” medical treatment. N Engl J Med 1991;325:512–515.
Cranford RE. Helga Wanglie’s ventilator. Hastings Cent Rep 1991;12(4):23,24.
Morreim EH. Profoundly diminished life: the casualties of coercion. Hastings Cent Rep 1994;24(1):33–42.
Daar JF. Medical futility and implications for physician autonomy. Am J Law Med 1995;21:221–240.
Lantos JD. Futility assessments and the doctor-patient relationship. J Am Geriatr Soc 1994;42:868–870.
Youngner SJ. Applying futility: saying no is not enough. J Am Geriatr Soc 1994;42:887–889.
Jecker NS, Schneiderman LJ. Futility and rationing. Am J Med 1992;92:189–196.
Society of Critical Care Medicine. Consensus report on the ethics of forgoing life-sustaining treatments in the critically ill. Crit Care Med 1990;18:1435–1439.
Taylor RM, Lantos JD. The politics of medical futility. Issues Law Med 1995;11:3–12.
Halevy A, Neal RC, Brody BA. The low frequency of futility in an adult intensive care unit setting. Arch Intern Med 1996;156:100–104.
Prendergast TJ, Claessens MT, Luce JM. A national survey of end-of-life care for critically ill patients. Am J Respir Crit Care Med 1998;158:1163–1167.
Ethics Committee of the Society of Critical Care Medicine. Recommendations for end-of-life care in the intensive care unit: the Ethics Committee of the Society of Critical Care Medicine. Crit Care Med 2001;29:2332–2348.
Prendergast TJ. Resolving conflicts in end-of-life care. New Horizons 1997;5:62–71.
Fisher R, Ury W, Patton B. Getting to Yes: Negotiating Agreement Without Giving In, 2nd rev. ed. Viking Penguin Books, New York: 1991.
Fins JJ, Solomon MZ. Communication in intensive care settings: the challenge of futility disputes. Crit Care Med 2001;29 Suppl:N10-N15.
Orr RD, deLeon D. The role of the clinical ethicist in conflict resolution. J Clin Ethics 2000;11:21–30.
West MB, Gibson JM. Facilitating medical ethics case review: what ethics committees can learn from mediation and facilitation techniques. Cambridge Q Healthcare Ethics 1992;1:63–74.
Jurchak M. Report of a study to examine the process of ethics case consultation. J Clin Ethics 2000;11:49–55.
Tomlinson T, Czlonka D. Futility and hospital policy. Hastings Cent Rep 1995;25(3):28–35.
Lundberg GD. American health care system management objectives. The aura of inevitability becomes incarnate. JAMA 1993;269:2554,2555.
Society of Critical Care Medicine Ethics Committee. Consensus statement of the Society of Critical Care Medicine’s Ethics Committee regarding futile and other possibly inadvisable treatments. Crit Care Med 1997;25:887–891.
Schneiderman LJ, Capron AM. How can hospital futility policies contribute to establishing standards of practice? Cambridge Q Healthcare Ethics 2000;9:524–531.
American Medical Association Council on Ethical and Judicial Affairs. Medical futility in end-of-life care: report of the Council on Ethical and Judicial Affairs. JAMA 1999;281:937–941.
Spielman B. Collective decisions about medical futility. J Law Med Ethics 1994;22:152–160.
Halevy A, Brody BA. A multi-institution collaborative policy on medical futility. JAMA 1996;276:571–574.
Bay Area Network of Ethics Committees (BANEC) Nonbeneficial Treatment Working Group. Nonbeneficial or futile medical treatment: conflict resolution guidelines for the San Francisco Bay Area. West J Med 1999;170:287–290.
Fine RL. The Texas Advance Directives Act of 1999: politics and reality. HEC Forum 2001;13:59–81.
Fine RL, Mayo TW. Resolution of futility by due process: early experience with the Texas Advance Directives Act. Ann Intern Med 2003;138:743–746.
Menikoff J. Demanded medical care. Ariz St Law J 1998;30:1091–1126.
Annas GJ. Asking the courts to set the standards of emergency care — the case of Baby K. N Engl J Med 1994;330:1542–1545.
Schneiderman LJ, Faber-Langendoen K, Jecker NS. Beyond futility to an ethic of care. Am J Med 1994;96:110–114.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bernat, J.L. Medical futility. Neurocrit Care 2, 198–205 (2005). https://doi.org/10.1385/NCC:2:2:198
Issue Date:
DOI: https://doi.org/10.1385/NCC:2:2:198
Key Words
- Futility
- medical treatment
- ineffectiveness
- Ethics Committee
- patient-physician relationship