Is Medical Futility an Ethical or Clinical Concept?

Abstract

The concept of medical futility first appeared at the end of the 1980s, was developed throughout the 1990s, and now is widely cited in medical literature and clinical practice to justify refraining from or limiting the use of life-sustaining therapies. The definition of medical futility, however, is not very clear or universally accepted. In this article, we examine the strengths and limitations of a particular concept of medical futility, based exclusively on clinical considerations, that enables the physician to make unilateral decisions about whether to withhold, withdraw, or continue treatment without being required to consult the patient or his family. To respect the patient’s spiritual, philosophical, and ethical values, several significant ethical issues need to be narrowly defined, and the concept of medical futility must be rarely invoked to justify such unilateral decisions.