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FAST FACT AND CONCEPT #136: Medical Futility
Authors: Joy E. Cuezze, MD and Christian T. Sinclair, MD |
The term “medical futility” is
commonly used by health professionals to discuss the appropriateness of a
medical treatment option. Texas and California have defined statewide
futility policy and increasingly hospitals and nursing homes are
developing their own futility policies. This Fast Fact will discuss the
current understanding of the term futility
The public, policymakers, ethicists and the medical profession have been
unable to agree on a clear, concise definition of futility that can be
applied to all medical situations. One commonly used definition is that a
futile intervention is one that a) is unlikely to be of any benefit to a
particular patient in a particular medical situation, and b) will not
achieve the patient’s intended goals. The sticking point in all futility
definitions is the concept of benefit, as the perception of benefit is
highly subjective. Physicians, patients and families often have very
different views on what is potentially beneficial. For example, although a
physician may believe that renal dialysis in an elderly demented patient
is futile, the family that views preservation of life at all costs as part
of their cultural ethos, may view dialysis as an important intervention to
continue life. Furthermore, medical futility can be easily misunderstood
as health care rationing. While economic issues may impact shared decision
making, the ultimate question is not "how much does this therapy cost?"
rather, "do the advantages of this therapy outweigh the disadvantages in a
given patient?"
Two types of futility have been described. Quantitative futility refers to
the intervention that has a very small chance of benefiting the
patient—the most commonly used number is < 1% chance of success. The term
qualitative futility describes a situation in which the quality of benefit
an intervention will produce is exceedingly poor. However, neither
approach is adequate as there is no consensus on either numeric thresholds
for quantitative futility nor shared understanding of what constitutes
qualitative benefits.
Physicians are not legally, professionally or ethically required to offer
medically futile treatments, as defined by the standard of care of the
medical community. Ethics committees, hospitals, and local/state medical
organizations can provide resources to understand medical futility and
professional responsibilities in one’s practice area.
Suggestions
Check with your health care institution re: the presence of an existing
futility policy.
avoid using the term “futility” in discussion with patients/families;
rather, speak in terms of benefits/burdens of treatment and patient or
family-specific goals of care.
involve a palliative care and/or ethics consultant in any situation where
“futility” will be invoked as process step in formulating decisions.
References
Doty WD, Walker RM. Medical Futility. Clinical Cardiology. 2000; 23:
II6-II16.
Schneiderman LJ, Jecker NS, Jonsen AR. Medical futility: Its Meaning and
Ethical Implications. Annals of Internal Medicine. 1990;112:949-954.
Cantor MD, et al. Do not resuscitate orders and medical futility. Arch
Intern Med 2003; 163:2689-2694.
Copyright/Referencing Information : Users are free to download and
distribute Fast Facts for educational purposes only. Citation for
referencing: Cuezze JE and Sinclair CT . Medical Futility. Fast Facts and
Concepts #136: April 2005. End-of-Life Physician Education Resource Center
www.eperc.mcw.edu.
Disclaimer: Fast Facts provide educational information, this information
is not medical advice. Health care providers should exercise their own
independent clinical judgment. Some Fast Fact information cites the use of
a product in dosage, for an indication, or in a manner other than that
recommended in the product labeling. Accordingly, the official prescribing
information should be consulted before any such product is used.
Creation Date: 4/2005
Purpose: Self-Study Guide, Teaching
Audience(s)
Training: Fellows, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6,
Physicians in Practice
Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General
Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN,
Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery
Non-Physician: Nurses
ACGME Competencies: Systems Based Practice, Professionalism, Patient Care
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