Medical Futility

Medical futility is one of the most controversial concepts in biomedical ethics. Different people have proposed diverse definitions. Nevertheless, decisions about medical futility have tremendous impacts on clinical practice and physician-patient relationships. The most fundamental dispute about medical futility is whether or not value-laden judgments regarding medical futility are acceptable.

In this essay, I argue that value-laden judgments of medical futility are necessary in clinical settings because a majority of "futility " debates have focused on medical problems requiring value-laden judgments. Value judgments made by physicians can be used in the form of recommendation given in the process of informed consent. Physicians' value judgments might be well informed and calm.

I believe that imposing one's value on others is one thing and having a certain position about value is the other. Physicians should establish their ethical attitudes in physician-patient relationships, but I strongly object to physicians' imposing their value judgments on patients and their family in any situation. In most "futility" cases, physicians must not withhold information about medical interventions that they believe are futile. It is essential for physicians to openly discuss their beliefs regarding what makes a human life valuable and what constitutes benefits with their patients and patients' families. There are many barriers to a physician making sound value judgments. Therefore, it is mandatory for physicians to be aware that they are making value judgments about medical interventions and recognize that value judgments could be biased by self-interest. It is also important for them to admit that physicians have no expertise in value judgments about individual cases.

The word futility comes from the Latin word meaning leaky (futilis). According to the Oxford English Dictionary, a futile action is "leaky, hence untrustworthy, vain, failing of the desired end through intrinsic defect." A futile action is one that cannot achieve the goal of the action, no matter how often repeated. The likelihood of failure may be predictable because it is inherent in the nature of the action proposed, and it may become immediately obvious or may become apparent only after many failed attempts. In clinical settings, medical futility is a term to refer to medical treatments that are unlikely to achieve their desired aims. Medical futility is, however, one of the most controversial concepts in biomedical ethics. Different people have proposed diverse definitions. All of the following have been referred to as futile treatment so far: whatever is highly unlikely to be efficacious, a low-grade outcome that is virtually certain, and whatever is highly likely to be more burdensome than beneficial. Thus, the term futility is now used to cover both situations of predicted impossibility and situations in which there are competing interpretations of probabilities and competing value judgments such as a balance of probable benefits and burdens.

The concept of medical futility has significant ethical implications in clinical practice. This is because whether or not a certain intervention is futile could determine physicians' obligation to offer medical interventions and even the information about it when informed consent is obtained. Many physicians and medical communities have declared that the duty to present an intervention as an option to a patient or the patient's family is mitigated or eliminated if the intervention is regarded as futile. Physicians may reject patient's or surrogate's requests for it and may be spared invasive procedures that offer no benefit, and resources may not be wasted. In terms of informed consent, information about futile treatments may not be provided to the patient in the first place. Some physicians have claimed that physicians can permissibly judge a treatment to be futile and are entitled to withhold a procedure, and that, in that case, they should act in accordance with other health care professionals, without obtaining consent from patients or family member. For instance, use of a mechanical ventilator could be judged futile for a conscious patient suffering respiratory failure with end-stage lung cancer. In this case, some would claim that physicians in charge of the patient's care could withhold the information about mechanical ventilation when they discuss treatment plan with the patient and/or the patient's family. Even if the family demands the physicians to use artificial respiratory support for the patient, they could reject the demand based on the judgment that such an intervention is futile, claiming that the judgment of futility is a matter of professional expertise. Thus, decisions about medical futility have tremendous impacts