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Council Report
March 10, 1999

Medical Futility in End-of-Life Care: Report of the Council on Ethical and Judicial Affairs

Author Affiliations

Members of the Council on Ethical and Judicial Affairs:(this list reflects members of the council when the report was originally prepared) Charles W. Plows, MD (chair); Robert M. Tenery, Jr, MD (vice chair); Alan Hartford, MD, PhD; Dwight Miller; Leonard Morse, MD; Herbert Rakatansky, MD; Frank A. Riddick, Jr, MD; Victoria Ruff, MD; George Wilkins, Jr, MD; Michael Ile, JD (council secretary); Jeffrey Munson (senior staff associate); Stephen R. Latham, JD, PhD (ethics division director); and Linda L. Emanuel, MD, PhD (vice president for ethics standards and staff author).

JAMA. 1999;281(10):937-941. doi:10.1001/jama.281.10.937

Use of life-sustaining or invasive interventions in patients in a persistent vegetative state or who are terminally ill may only prolong the dying process. What constitutes futile intervention remains a point of controversy in the medical literature and in clinical practice. In clinical practice, controversy arises when the patient or proxy and the physician have discrepant values or goals of care. Since definitions of futile care are value laden, universal consensus on futile care is unlikely to be achieved. Rather, the American Medical Association Council on Ethical and Judicial Affairs recommends a process-based approach to futility determinations. The process includes at least 4 steps aimed at deliberation and resolution including all involved parties, 2 steps aimed at securing alternatives in the case of irreconcilable differences, and a final step aimed at closure when all alternatives have been exhausted. The approach is placed in the context of the circumstances in which futility claims are made, the difficulties of defining medical futility, and a discussion of how best to implement a policy on futility.