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February 22, 1993

Futility and Its Wider Implications: A Concept in Need of Further Examination

Author Affiliations

Department of Medicine University of Illinois College of Medicine at Peoria One Illini Drive, Box 1649 Peoria, IL 61656-1649

Arch Intern Med. 1993;153(4):429-431. doi:10.1001/archinte.1993.00410040009002

The ARTICLE by Schneiderman and Jecker that appears in this issue of the Archives1 addresses an ever more important issue in medical practice. Many, if not most, patients who die in our hospitals today die not because life at that particular point in time could not have been prolonged but because a conscious decision to discontinue or refrain from starting treatment was deliberately made. Further treatment, which could have prolonged life, was decided against. Almost invariably, there is one more thing that can be done, one more apparatus that can be employed to substitute for natural function or one more drug or method that might be used. Often, patients or their surrogates ask that treatment be discontinued but, at other times, patients or surrogates not only request but insist on treatment that, in the best available medical judgment and born out by the literature, is to no avail. Such