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The concept of medical futility often arises when patients or surrogate decision-makers request interventions that medical professionals view as being without benefit or having a significant risk of causing undue harm. However, the concept of futility is fraught with ethical challenges as it often involves judgments about what constitutes a reasonable risk/benefit ratio or acceptable quality of life. In cases where an intervention could reasonably accomplish the physiologic goal, but strong ethical arguments can be made against it, the intervention should instead be termed “potentially inappropriate.” When making decisions regarding potentially inappropriate interventions, it is important for the medical team to maintain clear, open communication with the patient and family. In addition, advanced care planning, appropriate consultation, and aggressive palliation can be helpful in minimizing conflict and ensuring patients receive appropriate care which is in keeping with their medical goals. Decisions regarding resuscitation are often emotionally charged, and conflict can arise when medical providers feel resuscitative efforts are not indicated but patients/families want “everything” to be done. It is important for care teams to fully understand the patient’s goals as related to resuscitation and past experiences which may be influencing their decision. In addition, the team should ensure that the patient/family is as informed as possible regarding prognosis and the risks/benefits associated with resuscitation attempts in their specific case. If resuscitation is clearly inappropriate, providers should advocate for the patient to be “do not resuscitate” and could consider employing the concept of informed assent.

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Correspondence to Gregory A. Holton MD .

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Holton, G.A., Catic, A.G. (2017). Medical Futility. In: Catic, A. (eds) Ethical Considerations and Challenges in Geriatrics. Springer, Cham.

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