November 20, 1996

The Houston Citywide Policy on Medical Futility

Author Affiliations

Minnesota Center for Health Care Ethics Minneapolis

JAMA. 1996;276(19):1549-1550. doi:10.1001/jama.1996.03540190021012

To the Editor.  —The Houston Task Force1 has made a major contribution to discussions of medical futility policies. Its members suggest replacing efforts at defining medical futility with efforts at developing a fair procedural mechanism for resolving disputes—a mechanism that acknowledges the importance of professional and institutional integrity and balances these with respect for patient autonomy. The proposed institutional review mechanism, however, has too singular a concern with confirming or rejecting a physician's judgment of medical inappropriateness (or violation of professional or institutional integrity) to fully accomplish their worthy objective. It is particularly puzzling that the Houston policy assumes that respect for professional and institutional integrity should always take priority over respect for patients, when the goal is to fairly balance these 2 obligations.There are several assumptions implicit in the policy requiring further consideration, including the following: violations of professional or institutional integrity are simple all-or-nothing determinations; patient or surrogate