The Physician's Authority to Withhold Futile Treatment

Abstract

The debate over futility is driven, in part, by physicians' desire to recover some measure of decision-making authority from their patients. The standard approach begins by noting that certain interventions are futile for certain patients and then asserts that doctors have no obligation to provide futile treatment. The concept of futility is a complex one, and many commentators find it useful to distinguish 'physiological futility' from 'qualitative futility'. The assertion that physicians can decide to withhold physiologically futile treatment generates little controversy. The claim that they can withhold qualitatively futile treatment runs afoul of standard objections to medical paternalism. There is reason to believe that the conceptual distinction will not be maintained in clinical practice. This paper contends that the scientific data which would support a physician's unilateral decision to withhold physiologically futile treatment also provide support for an institutional policy restricting access to the treatment. The data the doctor uses to take decision-making power out of the hands of the patient can be used by the administrator to take power out of the hands of the doctor. While this loss of power is unproblematic, there is reason to believe that the ambiguity in the term 'futility' will allow a much greater loss of physicians' power.

When is clomiphene or gonadotropin intrauterine insemination futile? Results of the Fast Track and Standard Treatment Trial and the Forty and Over Treatment Trial, two prospective randomized controlled trials

“…According to the Ethics Committee Opinion on poor prognosis patients, “the provision of futile therapies is not ethically justifiable” in most cases, based on the non-existent or extremely remote chance of success, along with the potential for physiologic and psychological harm to the patient (12). Some ethicists go even further, suggesting that physicians have a professional duty to withhold treatment that may be potentially harmful and unlikely to achieve the desired result (13, 14). The observation that no live births occurred among women with FSH 10–15 mIU/mL and E2 ≥40 pg/mL treated with IUI challenges the current paradigm of stepwise treatment for these patients in mandated states, where several cycles of CC-IUI may still be required by some insurers prior to the initiation of IVF.…”

Long-term Ventilation for Patients With Duchenne Muscular Dystrophy

“…Furthermore, whether or not a patient is offered a life-sustaining therapy may depend on who his or her doctor is, rather than the patient's individual circumstances. 21 What then is the role of the physician in the decision-making process? The majority of the physicians (57.1%) in the study reported that they always present information to patients and families in an impartial manner, rather than recommend or advise against mechanical ventilation.…”

Fertility treatment when the prognosis is very poor or futile: a committee opinion

“…In such circumstances, clinicians may refuse to begin treatment or decline to continue with the current protocol (2). Indeed, some ethicists argue that clinicians have a duty to withhold treatments that threaten harm and probably will not achieve their intended goal (3,4).…”