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February 22, 1993

Futility in Practice

Author Affiliations

La Jolla, Calif; Seattle, Wash

Arch Intern Med. 1993;153(4):437-441. doi:10.1001/archinte.1993.00410040013003

ALTHOUGH THE term futility is actively used in medical discourse, critics object to the concept, calling it "elusive,"1 "unsettling" (Am Med News. November 11, 1991:28),"dangerous,"2 and devoid of a "clear sense of public values."3 If such objections prevail, they will effectively undermine assertions made by a wide variety of authorities that physicians are not obligated to provide futile treatment.4-8 Must futility be construed only as an ambiguous concept, cited in the abstract, or can it be defined with sufficient specificity to be useful in clinical practice?

Much of the resistance to the notion of futility, we believe, derives from the fear that it will serve as a masquerade for less defensible motivations. For example, will its acceptance revive discarded abuses of medical paternalism? Will it reverse recent advances in patient autonomy and shared decision making? Will the power to declare treatment futile provide a convenient excuse for