Observations Ethics Man

The slipperiness of futility

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b2222 (Published 05 June 2009) Cite this as: BMJ 2009;338:b2222
  1. Daniel K Sokol, lecturer in medical ethics and law, St George’s, University of London
  1. daniel.sokol{at}talk21.com

    When clinicians deem an intervention to be futile, what do they actually mean?

    He was shot in the back. The surgeons could not save him. He lay in bed, unconscious, his life ebbing away as blood trickled down tubes to large jars at the base of his bed. As cardiopulmonary resuscitation would have been futile, we wrote a “Do not attempt resuscitation” order. The case reminded me of the etymology of the word “futile.” “Futilis” in Latin means “leaky.” The patient was leaking blood from various wounds, and nothing could stop it.

    At a recent examiners’ meeting, a professor of surgery admitted that he would have got the ethics question wrong. The question concerned the definition of futility. “So how would you define futility?” I asked. He paused and, like Humpty Dumpty in Through the Looking Glass, answered: “Something is futile if I say it is.” This remark highlights the semantic slipperiness and subjectivity of the term “futile.” Yet, in the clinical frontline, futility, coated with a veneer of objectivity, is often used as a moral trump card, a dismissive pronouncement to end all discussion: “I’m sorry. …

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