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Editor's Correspondence
January 08, 2001

Abuse of Futility—Reply

Author Affiliations

Copyright 2001 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2001

Arch Intern Med. 2001;161(1):128-130. doi:

In reply

If the medical futility rationale is to have any role in medical care, it is essential that clinicians be precise and unbiased in its use. Furthermore, when medical futility is applied to a given intervention for a given patient, it is essential that clinicians rely on rigorous application of outcome data or clinical experience to confirm its application. On these points we agree with Drs Schneiderman, Jecker, and Jonsen. In their letter to the editor these authors misunderstood the purpose of the scenario we posed in our recent article in the ARCHIVES.1 The purpose of our study was not to define medical futility, but to examine the attitudes of patients toward the application of the principle of medical futility to a specific treatment in their own care. The scenario assumed that the physician caring for the patient had enough additional information to warrant the determination of medical futility. We were not implying that mechanical ventilation is futile therapy for all patients with advanced AIDS and acute respiratory failure. On the contrary, 1 of us (J.R.C.) recently published an article showing that 40% of all patients with Pneumocystis carinii pneumonia and respiratory failure survived to hospital discharge. The article also made the explicit point that mechanical ventilation is not futile for these patients as a group.2 In our hypothetical scenario, we assumed that clinicians had enough additional information on other conditions of the patient (eg, multiple organ failure and deterioration despite aggressive therapy) to determine that mechanical ventilation would be medically futile for the specific patient with advanced AIDS who had an overall prognosis from underlying disease of 3 months to live. Our purpose was to elicit patient response to this assessment.

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