Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles.
I have read with pleasure the article by Daniel K Sokol
(1). Everyone must agree that while treatment may be futile, care never
is. Although the classification of futility provided in the article is a
useful one it does not take into account value judgements. Declaration of
qualitative futility, termed value futility by Mohindra (2), may well
require value judgement by the treating physician on behalf of the
patient. Such decisions while well intended are based on a medical or
personal set of values, which may be distinct from those of the patient;
something that the author alludes to.
Assumptions when withdrawing care
may easily lead to conflict. Good communication with the patient or those
representing his or her interests is essential. Furthermore discarding
‘semantically fuzzy’ concept of futility may be a wrong strategy given the
increasingly consumer driven health care. There is no moral obligation to
provide treatment that is ‘futile’. Strategies for managing futility are
provided in the GMC guidance (3). It provides a framework for withdrawing
and withholding treatment placing emphasis on care of the dying. Mental
Capacity Act 2005 provides further guidance in cases where it may be
difficult to determine patient’s best interests. The topic of futility
deserves more attention as medicine has its limits - something both
patients and doctors need to keep in mind.
1. Sokol D K The slipperiness of futility BMJ 2009;338:1418
2. Mohindra R K Medical futility: a conceptual model J Med Ethics
2007;33:71-75
Regarding futility
Dear Editor,
I have read with pleasure the article by Daniel K Sokol
(1). Everyone must agree that while treatment may be futile, care never
is. Although the classification of futility provided in the article is a
useful one it does not take into account value judgements. Declaration of
qualitative futility, termed value futility by Mohindra (2), may well
require value judgement by the treating physician on behalf of the
patient. Such decisions while well intended are based on a medical or
personal set of values, which may be distinct from those of the patient;
something that the author alludes to.
Assumptions when withdrawing care
may easily lead to conflict. Good communication with the patient or those
representing his or her interests is essential. Furthermore discarding
‘semantically fuzzy’ concept of futility may be a wrong strategy given the
increasingly consumer driven health care. There is no moral obligation to
provide treatment that is ‘futile’. Strategies for managing futility are
provided in the GMC guidance (3). It provides a framework for withdrawing
and withholding treatment placing emphasis on care of the dying. Mental
Capacity Act 2005 provides further guidance in cases where it may be
difficult to determine patient’s best interests. The topic of futility
deserves more attention as medicine has its limits - something both
patients and doctors need to keep in mind.
1. Sokol D K The slipperiness of futility BMJ 2009;338:1418
2. Mohindra R K Medical futility: a conceptual model J Med Ethics
2007;33:71-75
3. GMC Withholding and withdrawing life-prolonging treatments guidance –
http://www.gmc-
uk.org/guidance/current/library/witholding_lifeprolonging_guidance.asp
Competing interests:
None declared
Competing interests: No competing interests