Ten Common Questions (and Their Answers) on Medical Futility

Abstract

The term medical futility is frequently used when discussing complex clinical scenarios and throughout the medical, legal, and ethics literature. However, we propose that health care professionals and others often use this term inaccurately and imprecisely, without fully appreciating the powerful, often visceral, response that the term can evoke. This article introduces and answers 10 common questions regarding medical futility in an effort to define, clarify, and explore the implications of the term. We discuss multiple domains related to futility, including the biological, ethical, legal, societal, and financial considerations that have a bearing on definitions and actions. Finally, we encourage empathetic communication among clinicians, patients, and families and emphasize how dialogue that seeks an understanding of multiple points of view is critically important in preventing or attenuating conflict among the involved parties.

Reasons doctors provide futile treatment at the end of life: a qualitative study

“…Futile treatment, its meaning and causes have been vigorously debated over some decades 1 2. Consensus as to how to define this concept is unlikely,1 3 but most definitions centre on the likelihood and degree of benefit to a patient 2 4 5.…”

“…Consensus as to how to define this concept is unlikely,1 3 but most definitions centre on the likelihood and degree of benefit to a patient 2 4 5. Despite a lack of consensus on the definition of futility, there is a growing body of international empirical evidence that doctors provide futile treatment6–12 (or, to use a broader concept, ‘perceived inappropriate treatment’)13–16 to adult patients at the end of life.…”

Palliative care for patients with end-stage renal disease: approach to treatment that aims to improve quality of life and relieve suffering for patients (and families) with chronic illnesses

“…In the case of Mrs. M, the risk of HD treatment outweighed the benefits. Whether treatment is considered medically futile is difficult because whoever defines the situational futility often skews it to meet their point of view [23]. Deciding to continue or cease dialysis in patients that are deteriorating clinically is particularly challenging for nephrologists when the patient no longer possesses the capacity to make decisions [7].…”

“…When examining physiologic futility, the efficacy of the treatment and/or technology is assessed for its ability to fulfill its intended purpose in a given patient [23]. With respect to HD, it must be determined whether it is adequately replacing the patient's renal function.…”

Usefulness of Palliative Care to Complement the Management of Patients on Left Ventricular Assist Devices

“…Identifying when care becomes futile is difficult in any circumstance, but once again, open communication and having explicitly defined— and realistically set—goals of therapy from a patient perspective can greatly prevent or resolve many such conflicts. 30 …”