Pulling the plug on futility

Futility is not the ethical trump card that some would like it to be

If the fashionableness of a new idea can be measured by the number of publications it generates these are piping times for the idea of “medical futility.” As it has been developed in the medical literature futility provides a basis for doctors to refuse demands for treatment from patients and families. According to the results of a Medline search, articles on futility have undergone a small scale population explosion: two articles in 1987, five in 1990, and 23 in 1993. As with any new intellectual tack, after the initial intoxication has begun to wear off we must ask soberly: “Are we any further ahead?”

The idea of futility is admittedly seductive. Over the past few years the familiar “right to die” issue has been turned on its head. Rather than refusing life sustaining treatment in the face of intransigent doctors, patients (and their surrogates) have begun to demand treatment that doctors are reluctant to provide, either because its efficacy is questionable or, more problematically, because it serves goals that the doctors are reluctant to endorse. The most contentious of these cases have been those in which families have asked for aggressive life sustaining treatment for anencephalic children1 or patients in …