Many have attempted to justify certain acts of disruptive climate activism by appealing to, at least in part, their effectiveness. Accordingly, they help raise awareness, assure others that many will participate in the collective action, pressure politicians, call for change in governmental policies, and/or directly frustrate environmentally damaging industries. But what if the climate disaster is inevitable? What if climate protests and resistance are futile? Should this be the case, we cannot appeal to the instrumental value realized to justify the (...) costs (or even harm) imposed by activists, as those would be gratuitous costs (or harm). Nevertheless, we believe that futile climate activism can be justified as fitting protest, that is, as a form of fitting expression against serious disregard for the lives of others. Violent climate resistance can satisfy the conditions of correct directedness, type appropriateness, proportionality, and adequacy, and is thus called for in situations of futility. The conditions of fitting protest may have further implications for protests that aim to bring about political or social change. (shrink)

For many years a debate has raged over what constitutes futile medical care, if patients have a right to demand what doctors label as futile, and whether physicians should be obliged to provide treatments that they think are inappropriate. More recently, the argument has shifted away from the difficult project of definitions, to outlining institutional policies and procedures that take a measured and patient-by-patient approach to deciding if an existing or desired intervention is futile. The prototype is the Texas Advance (...) Directives Act, but similar procedures have been widely implemented both with and without the protection of the law. While this method has much to recommend it, there are inherent moral flaws that have not received as much discussion as warranted. Because these strategies adopt a semblance of procedural justice, it is assumed that the outcomes of such proceedings will be both correct and fair. In this paper, I argue that there are three main irremediable defects in the policy approach: there is the potential for arbitrary decision-making about futility in specific cases; there are structural, pre-ordained consequences for ethnic minorities who would be disproportionately affected by the use of these procedures; and the use of rationing justifications to support the use of these policies. These flaws detract so much from any benefit that could be derived that they make such strategies more harmful than helpful. (shrink)

Comparatively little scholarly attention has been given to the question of futility in chronic psychiatric disorders, with the exception of a small body of work on so-called end-stage anorexia nervosa. A review of this literature provides the background for a critical examination of whether the concept of futility has any clinically meaningful, ethically justifiable, and legally defensible application to AN. In this article, the arguments for and against futility judgments in AN are analyzed with special emphasis on (...) determinations of capacity in this serious mental illness. Parallels between the futility disputes in medical and psychiatric disorders, where applicable, will be drawn to further illuminate whether or not the concept that continued psychiatric treatment for AN is ever truly futile. (shrink)

Medical futility laws protect surrogate decision makers by constraining clinicians and hospitals. Professor Fiester shows that clinicians and surrogate decision makers often have different value systems. Clinicians espouse the “Best Interest Values” (BIV) system, while surrogates often espouse the “Life-Continuation Values” (LCV) system. Professor Fiester argues that there is no way to adjudicate between the BIV and LCV value systems. They are incommensurable and irreconcilable. Surrogates are not “wrong” about the patient’s best interest. They just measure it differently. Consequently, (...) because clinicians have no superior ethical claim to determine the patient’s best interest, they should not impose their value-laden notion onto surrogates. I question whether clinicians are as powerful as Professor Fiester suggests. In fact, laws in many U.S. states materially constrain clinicians and hospitals, requiring them to do precisely what the LCV surrogate wants. Therefore, in these jurisdictions, clinicians are already forced to undertake the “constructive engagement” that Professor Fiester calls for. In these states, the BIV does not subjugate the LCV. Rather, the LCV likely subjugates the BIV. (shrink)

The provision of intensive care enables the lives of neonates, infants and children to be sustained or extended in circumstances previously regarded as impossible. However, as well as benefits, such care may confer burdens that resultingly frame continuation of certain interventions as futile, conferring more harm than or any, benefit. Subsequently, clinicians and families in the paediatric intensive care unit are often faced with decisions to withdraw, withhold or limit intensive care in order to act in the best interests of (...) the child. An integral consideration in respect of these decisions is that futility is a concept that has to be contextualised for all those involved. Recent high-profile legal cases highlight the professional, clinical, legal and social conflicts that can arise when parents and clinicians have different interpretations of futility. In acknowledging the complexity of these conflicts for clinicians, this paper aims to support a better understanding of futility as an integral concept in such difficult and emotive decisions within professional practice. We utilise the concept of futility to frame how these decisions to withdraw or withhold certain invasive life-prolonging interventions are ethically and legally justifiable, even when they disagree or conflict with parental views. To support clinicians in understanding these decisions, we in part use the familiar bioethical framework of Principlism developed by Beauchamp and Childress. We suggest that understanding legal and ethical analysis of futility ultimately will help clinicians in approaching and reflecting on such decision-making. (shrink)

It has been reported as an ethical problem within prehospital emergency care that ambulance professionals administer physiologically futile cardiopulmonary resuscitation (CPR) to patients having suffered cardiac arrest to benefit significant others. At the same time it is argued that, under certain circumstances, this is an acceptable moral practice by signalling that everything possible has been done, and enabling the grief of significant others to be properly addressed. Even more general moral reasons have been used to morally legitimize the use of (...) futile CPR: That significant others are a type of patient with medical or care needs that should be addressed, that the interest of significant others should be weighed into what to do and given an equal standing together with patient interests, and that significant others could be benefited by care professionals unless it goes against the explicit wants of the patient. In this article we explore these arguments and argue that the support for providing physiologically futile CPR in the prehospital context fails. Instead, the strategy of ambulance professionals in the case of a sudden death should be to focus on the relevant care needs of the significant others and provide support, arrange for a peaceful environment and administer acute grief counselling at the scene, which might call for a developed competency within this field. (shrink)

The word “futility” derives etymologically from the Latin futilis (deprived of value, importance, interest, or usefulness). Medical futility was first used in medical practice when it became more scientifically oriented, technologically assisted (since the 1960s), and more invasive or aggressive.

Acts of futile resistance—harms against an aggressor which could not reasonably hope to avert the threat the aggressor poses—give rise to a puzzle: on the one hand, many such acts are intuitively permissible, yet on the other, these acts fail to meet the justificatory standards of defensive action. The most widely accepted solution to this puzzle is that victims in such cases permissibly defend against a secondary threat to their honour, dignity, or moral standing. I argue that this solution fails, (...) because futile resistance is not plausibly regarded as defensive in the relevant sense. I propose instead that futile resistance is justified as a form of protest, where protest is analysed as an expression of rejection of victims’ wrongs. Such protest is justified, I argue, when and because it is the fitting response to the circumstances of futility. (shrink)

So-called futile care : the experience of the Unied States -- The reality of medical futility in Brazil -- Medical futility and end-of-lfe issues in Belgium -- The concept of medical futility in Venezuela -- Medical futility in Russian Federation -- Medical futility in Australia -- Medical futility in Japan -- Ethical issues and policy in medical futility in China -- Medical futility in Korea -- Medical futility from Swiss perspective -- (...) Medical futility in Turkey -- Medical futility in the Untited Arab Emirates -- Medical futility in Iran. (shrink)

Our response to death may differ depending on the patient’s age. We may feel that death is a sad, but acceptable event in an elderly patient, yet feel that death in a very young patient is somehow unfair. This paper explores whether there is any ethical basis for our different responses. It examines in particular whether a patient’s age should be relevant to the determination that an intervention is medically futile. It also considers the responsibilities of health professionals and the (...) rights of family members in situations where an interventions is clearly futile. (shrink)

Objectives: Futile medical care is considered as the care or treatment that does not benefit the patient. Staff of intensive care units experience moral distress when they perceive the futility of care. Therefore, this study aimed to determine the relationship between perceptions of nurses regarding futile medical care and their caring behaviors toward patients in the final stages of life admitted to intensive care units. Method: This correlation, analytical study was conducted with 181 nursing staff of the intensive care (...) units of health centers affiliated to Mazandaran University of Medical Sciences, Mazandaran, Iran. The data collection tool included a three-part questionnaire containing demographic characteristics form, perception of futile care questionnaire, and caring behaviors inventory. To analyze the data, statistical tests and central indices of tendency and dispersion were investigated using SPSS, version 19. Pearson’s correlation coefficient, partial correlation, t-test, and analysis of variance tests were performed to assess the relationship between the variables. Ethical considerations: The study was reviewed by the ethics committee of the Mazandaran University of Medical Sciences. Informed consent was obtained from participants. Results: Our findings illustrated that the majority of nurses (65.7%) had a moderate perception of futile care, and most of them (98.9%) had desirable caring behaviors in taking care of patients in the final stages of life. The nurses believed that psychosocial aspects of care were of utmost importance. There was a significant negative relationship between perception of futile care and caring behavior. Conclusion: Given the moderate perception of nurses concerning futile care, and its negative impact on caring behaviors toward patients, implementing suitable interventions for minimizing the frequency of futile care and its resulting tension seems to be mandatory. It is imperative to train nurses on adjustment mechanisms and raise their awareness as to situations resulting in futile care. (shrink)

Objectives Medical futility at the end of life is a growing challenge to medicine. The goals of the authors were to elucidate how clinicians define futility, when they perceive life-sustaining treatment (LST) to be futile, how they communicate this situation and why LST is sometimes continued despite being recognised as futile. Methods The authors reviewed ethics case consultation protocols and conducted semi-structured interviews with 18 physicians and 11 nurses from adult intensive and palliative care units at a tertiary (...) hospital in Germany. The transcripts were subjected to qualitative content analysis. Results Futility was identified in the majority of case consultations. Interviewees associated futility with the failure to achieve goals of care that offer a benefit to the patient's quality of life and are proportionate to the risks, harms and costs. Prototypic examples mentioned are situations of irreversible dependence on LST, advanced metastatic malignancies and extensive brain injury. Participants agreed that futility should be assessed by physicians after consultation with the care team. Intensivists favoured an indirect and stepwise disclosure of the prognosis. Palliative care clinicians focused on a candid and empathetic information strategy. The reasons for continuing futile LST are primarily emotional, such as guilt, grief, fear of legal consequences and concerns about the family's reaction. Other obstacles are organisational routines, insufficient legal and palliative knowledge and treatment requests by patients or families. Conclusion Managing futility could be improved by communication training, knowledge transfer, organisational improvements and emotional and ethical support systems. The authors propose an algorithm for end-of-life decision making focusing on goals of treatment. (shrink)

Death and futility are among a cluster of themes that closely track discussions of life’s meaning. Moreover, futility is thought to supervene on naturalistic meta-narratives because of how they will end. While the nature of naturalistic meta-narrative endings is part of the explanation for concluding that such meta-narratives are cosmically or deeply futile, this explanation is truncated. I argue that the reason the nature of the ending is thought to be normatively important is first anchored in the fact (...) that narrative ending qua ending is thought to be normatively important. Indeed, I think futility is often thought to characterize naturalistic meta-narratives because a narrative’s ending has significant proleptic power to elicit a wide range of broadly normative human responses on, possibly, emotional, aesthetic, and moral levels towards the narrative as a whole. (shrink)

Since its introduction in the 1980s, futility as a concept has held contested meaning and applications throughout medicine. There has been little discussion within the psychiatric literature about the use of futility in the care of individuals experiencing severe and persistent mental illness (SPMI), despite some tacit acceptance that futility may apply in certain cases of psychiatric illness. In this paper, we explore the literature surrounding futility and argue that its connotation within medicine is to describe (...) situations where patients (or their substitute decision-makers) believe that interventions will almost certainly provide no meaningful benefit. We then provide two arguments in support of the use of futility within the care of individuals experiencing SPMI: that some SPMI can be considered a terminal illness, and that the risk-benefit ratio is a dynamic entity such that futility can help describe what Gillett calls the ‘risk of unacceptable badness’ when it comes to considering how an intervention might impact a patient’s quality of life. We posit that capacity should not pose an obstacle to declaring futility when caring for individuals experiencing SPMI and explain how futility is not antithetical to recovery in mental health. Finally, we describe how using futility within psychiatric practice can allow for a reorientation of care by signalling the need to shift to a palliative approach. (shrink)

The concept of futility in medicine refers to the incapability of an intervention to achieve its goal. Futility determinations form the basis for withholding and withdrawing life-sustaining interventions. Criticisms of attempted futility definitions relate to inconstant probability and value judgements concerning the goal pursued. This variability frustrates efforts to define futility. Language modifications and procedural approaches, both important ancillary measures, inherently lack the ability to resolve this difficulty. Beneath the notion of futility lie foundational factors (...) whose revised understanding is required to advance a definition. These factors include autonomy, death and the goals of medicine. Reconsidering the essence and influence of foundational factors is necessary to move beyond a seemingly irresolvable problem. In this essay, I assert that defining futility is not pointless but rather possible, necessary and unavoidable. With this assertion, I respond to the criticisms of futility. These responses together with a corrective understanding of foundational factors lead to a definition of futility. This definition balances respect for patients’ autonomy whilst allowing for interventions that do not undermine the essence of medicine and integrity of those practising it. Defining futility is an exercise in necessity requiring renewed perceptual foundations. (shrink)

Background: Despite the progress made in recent decades on the phenomenon of futility in adult intensive care, recognizing it during clinical care practice remains a complex and sensitive process, during which questions are often raised for which concrete answers are difficult to find. Aims: To analyze the frequency with which futile nursing interventions are implemented in critically ill patients admitted to adult intensive care in specific situations and how often futile autonomous and interdependent nursing interventions are implemented in the (...) same population, as perceived by adult intensive care nurses. Research design: Cross-sectional, quantitative, and descriptive study, which employed a questionnaire constructed specifically for this research to assess the perception of therapeutic futility in nursing in adult intensive care. Following an evaluation of the psychometric properties, the questionnaire was made available in an electronic format on the EUSurvey platform between August and October 2024. The data was analyzed between November 2023 and March 2024 using the statistical software packages SPSS and R. Participants and research context: A simple random sample of nurses working in level II and level III intensive care units in Portugal. Ethical considerations: Research ethical approvals were obtained, and the participants provided informed consent. Findings/results: Four hundred and fourteen valid questionnaires were obtained. The results allow the identification of thirty-three statistically significant associations, the inference of intervals for the mean and median for the perception of futility of nursing interventions with a 95% confidence interval, and enable the hierarchization of nursing interventions implemented in critically ill patients admitted to adult intensive care units according to the nurses’ perception of their futility. Conclusion: There is a balance in nurses' perception of the futility of their interventions in the specific situations analyzed. There is statistically significant evidence that interdependent nursing interventions are, in general, more frequently perceived as futile when compared to autonomous nursing interventions. (shrink)

As the rates of intravenous opioid use have increased, so have its associated medical complications, such as endocarditis, and known interventions, such as heart‐valve replacements. For many patients, including Jacob, whose case was brought to my psychiatric consult service and to my colleagues in the clinical ethics service, relapse increases the risk of repeat endocarditis and the need for repeat surgical interventions. Previous works have posed the bioethical quandary regarding the responsibilities of a surgeon in these repeat procedures and whether (...) a surgeon may ethically refuse to perform a repeat intervention in a patient who has relapsed. Notions of futility are commonly used to navigate this complex terrain, and they were the focus of the ethics consideration given to Jacob's case, in which surgeons were reluctant to perform valve replacements. In this narrative essay, I interrogate the concept of futility by appealing to its history and variable meanings, and I argue against its relevance in cases like Jacob's. I propose that a more suitable bioethical approach in such cases would consider resource allocation, the sociocultural stigma of addiction, and the interpersonal and narrative factors that make each case unique. (shrink)

This paper distinguishes four major types of futility (physiological, imminent demise, lethal condition, and qualitative) that have been advocated in the literature either in a patient dependent or a patient independent fashion. It proposes five criteria (precision, prospective, social acceptability, significant number, and non-agreement) that any definition of futility must satisfy if it is to serve as the basis for unilaterally limiting futile care. It then argues that none of the definitions that have been advocated meet the criteria, (...) primarily because their proponents have not paid sufficient attention to the problematic nature of the data supporting the use of their definitions. (shrink)

Hospital futility policies are ethically defensible, but they require the proper understanding of futility and should be embedded in a larger process for making decisions about limiting treatment.

This chapter discusses the film _My Life Without Me_ (2003) to set the stage for a discussion of the issue of futility of care. The film tells the story of Ann (Sarah Polley), who is diagnosed with terminal ovarian cancer that leaves her with only a few months to live. Ann is married to Don, with whom she has had two daughters. After receiving her diagnosis, she chooses to keep the condition secret from her loved ones, believing that this (...) is the one gift she can leave her family. The film draws attention to a broad range of tense emotional and moral concerns emerging from the world of modern neonatal medical care. Among these are: How should parents handle unexpected and devastating news about the health and welfare of their newborns? How do medical providers manage such tragic situations? What are minimally acceptable ways of demonstrating compassion for a dying child? Whose lives are impacted most by neonatal death? What makes a medical condition futile? Who should decide? (shrink)

This chapter uses the film _My Life Without Me_ (2003) to set the stage for a discussion of futility of care. The film tells the life story of Ann (Sarah Polley), a young woman rendered a diagnosis of a terminal illness. Ann, married and with two young children, knows she will die soon and decides to live her last days differently; she will do what she had wanted to do before but had not had the courage to try. (...) class='Hi'>Futility of care is an issue of everyday neonatal practice. It refers to “medical care that either prolongs suffering, does not improve the quality of life, or fails to achieve a good outcome for the patient.” Depending upon the country, there are three approaches to neonatal care: (a) the “treat until certainty” approach, whereby each infant is treated until death or discharge; (b) the “statistical” approach, whereby treatment is withheld from infants defined as underweight and/or immature; and (c) the “initiate and re-evaluate” approach, whereby aggressive treatment is begun and then reevaluated relative to the infant's progress and parents' wishes. (shrink)

Exemptions from laws of general application are sometimes granted on the basis of an individual’s unwillingness to comply with the law. Most such volitional exemptions involve a conflict between the law and the demands of an individual’s religious or secular moral convictions. I argue here that a limited number of volitional exemptions can be justified on the basis of a futility principle. When otherwise morally permissible penalties for violating the law cannot be expected to induce the compliance of an (...) intransigent minority, the penalties are futile, and the state has some principled reason to exempt the minority from the law’s requirements. Since the futility principle only applies to some cases of conscientious objection, it differs in important ways from justifications grounded in a general entitlement to religious or moral exemptions. [Pairs with "Exemptions for Conscience"]. (shrink)

This chapter discusses the issue of medical futility raised by the film _My Life_ (1993). The film focuses on public relations superstar Bob Jones (Michael Keaton), who has a terminal cancer, and his wife Gail (Nicole Kidman) who is pregnant with their first child. In one scene, Dr. Joseph Califano (Kenneth Tigar) tells Bob that his tumors have not responded to interleukin therapy and that he “can't recommend further treatment.” Bob responds by questioning the physician's right to deny him (...) treatment. The chapter argues that although competent patients have a virtually unlimited ability to refuse treatments, including life-sustaining treatments, the right to demand a treatment—especially one that physicians regard as “futile”—is much more controversial. The question is how to balance the competing claims of surrogate decision-makers and treating physicians (whose prognostic abilities are not infallible). The search for an answer to this question properly begins with a search for the source of futility disagreements. (shrink)

Partly because physicians can “never say never,” partly because of the seduction of modern technology, and partly out of misplaced fear of litigation, physicians have increasingly shown a tendency to undertake treatments that have no realistic expectation of success. For this reason, we have articulated common sense criteria for medical futility. If a treatment can be shown not to have worked in the last 100 cases, we propose that it be regarded as medically futile. Also, if the treatment fails (...) to restore consciousness or alleviate total dependence on intensive care, we propose such treatment be judged futile. This definition provides clear end points and encourages the profession to review data from the past and perform, prospective clinical studies that not only report treatments that work but also treatments that do not work. We have also argued that, in a variety of settings, physicians have no ordinary ethical obligation to offer futile interventions. Although physicians should inform, and discuss all decisions to withhold or withdraw medical treatments with patients, they need not obtain the patient's permission to desist from futile interventions. (shrink)

The concept of medical futility has come to be seen in some quarters as a value-neutral trump card when dealing with issues of power and conflicting values in medicine. I argue that this concept is potentially useful, but only in a social context that provides a normative framework for its use. This social context needs to include a broad consensus about the purpose of medicine and the nature of the physician-patient relationship.

In his Target Article, Matthew Shea (2025) argues that replacing the best interest standard with the more restrictive futility standard will promote justice for unrepresented patients, those who la...

‘Futility’ is a contentious term that has eluded clear definition, with proposed descriptions either too strict or too vague to encompass the many facets of medical care. Requests for futile care are often surrogates for requests of a more existential character, covering the whole range of personal, emotional, cultural and spiritual needs. Physicians and other practitioners can use requests for futile care as a valuable opportunity to connect with their patients at a deeper level than the mere biomedical diagnosis. (...) Current debate around Canada’s changing regulatory and legal framework highlights challenges in appropriately balancing the benefits and burdens created by requests for futile care. (shrink)

It probably should not be surprising, in this time of soaring medical costs and proliferating technology, that an intense debate has arisen over the concept of medical futility. Should doctors be doing all the things they are doing? In particular, should they be attempting treatments that have little likelihood of achieving the goals of medicine? What are the goals of medicine? Can we agree when medical treatment fails to achieve such goals? What should the physician do and not do (...) under such circumstances? Exploring these issues has forced us to revisit the doctor-patient relationship and the relationship of the medical profession to society in a most fundamental way. Medical futility has both a quantitative and qualitative component. I maintain that medical futility is the unacceptable likelihood of achieving an effect that the patient has the capacity to appreciate as a benefit. Both emphasized terms are important. A patient is neither a collection of organs nor merely an individual with desires. Rather, a patient (from the word to suffer ) is a person who seeks the healing (meaning to make whole ) powers of the physician. The relationship between the two is central to the healing process and the goals of medicine. Medicine today has the capacity to achieve a multitude of effects, raising and lowering blood pressure, speeding, slowing, and even removing and replacing the heart, to name but a minuscule few. But none of these effects is a benefit unless the patient has at the very least the capacity to appreciate it. Sadly, in the futility debate wherein some critics have failed or refused to define medical futility an important area of medicine has in large part been neglected, not only in treatment decisions at the bedside, but in public discussions—comfort care—the physician’s obligation to alleviate suffering, enhance well being and support the dignity of the patient in the last few days of life. (shrink)

This paper reframes the futility debate, moving away from the question “Who decides when to end what is considered to be a medically inappropriate or futile treatment?” and toward the question “How can society make policy that will best account for the multitude of values and conflicts involved in such decision-making?” It offers a pragmatist moral epistemology that provides us with a clear justification of why it is important to take best standards, norms, and physician judgment seriously and a (...) clear justification of why ample opportunity must be made for patients, families, and society to challenge those standards and norms. (shrink)

While the era following the Bland decision in 19931 might be thought of as the time when concepts such as ‘futility’ were placed under pressure and scrutiny, it’s an idea that has been debated for at least forty years. In a 1983 JME commentary Bryan Jennett distinguishes three kinds of reason why Cardiopulmonary Resuscitation might be withheld: > ‘… that CPR would be futile because it is very unlikely to be successful; that quality of life after CPR is likely (...) to be changed to so poor a level as to be a greater burden than the benefit gained from prolongation of life, and that quality of life is already so poor due to chronic or terminal disease that life should not be prolonged by CPR.’ pp-142-1432 This crisp definition seems as applicable as it did then, but it was not the final word on the concept. Mitchell, Kerridge and Lovat explore, as others did in the post-Bland and Quinlan eras, how ‘futility’ might apply to those in a …. (shrink)

In this essay I examine the formal structure of the concept of futility, enabling identification of the appropriate roles played by patient, professional, and society. I argue that the concept of futility does not justify unilateral decisions to forego life-sustaining medical treatment over patient or legitimate surrogate objection, even when futility is determined by a process or subject to ethics committee review. Furthermore, I argue for a limited positive ethical obligation on the part of health care professionals (...) to assist patients in achieving certain restricted goals, including the preservation of life, even in circumstances in which most would agree that that life is of no benefit to the patient. Finally, I address the objection that professional integrity overrides this limited obligation and find the objection unconvincing. In short, my aim in this essay is to see the concept of futility finally buried, once and for all. (shrink)

Most discussions of medical futility try to answer the Futility Question: when is a medical procedure futile? No answer enjoys universal support. Some futility policies say that the health care provider will answer this question when the provider and patient cannot agree. This raises the Decision Question: who has the moral authority to decide what to do in cases where futility is disputed? I look for a procedural answer to this question, an answer that does not (...) turn on whether a given party happens to answer the Futility Question correctly. I argue that these policies get it right; the provider should decide because providers have a right of conscientious refusal that extends to refusing procedures on grounds of futility. This is a procedural answer because providers have this right even if they are sincerely mistaken about whether a procedure is futile. (shrink)

The swift advancement of intensive care medicine, coupled with technological possibilities, has prompted numerous ethical inquiries regarding decision-making processes concerning the withholding or withdrawal of treatment due to medical futility. This study seeks to delineate the decision-making approaches employed by intensive care physicians in Türkiye when faced with medical futility at the end of life, along with an ethical evaluation of these practices. Grounded theory, a qualitative analysis method was employed, conducting semi-structured, in-depth interviews with eleven intensive care (...) physicians in Türkiye. The subsequent text analysis was carried out using MAXQDA software. Participants assert that the decisions made by Turkish physicians determine whether treatment is futile, rely on medical consensus, and lack a standardized decision-making process. The decisions are influenced by legal and social pressures, resource constraints, and occasional conflicts of interest. The significance of professional hierarchy is notable, with limited consideration given to the opinions of nurses and other staff. The unstructured medical consensus processes are shaped by normative concepts such as benefit, age, justice, and conscience. Furthermore, it was observed that the conscientious opinions of physicians carry more weight than adherence to ethical principles and guidelines. To create optimal conditions for doctors to make ethically justifiable decisions, the dynamics within the treatment team should be improved, emphasizing the minimization of hierarchy, and ensuring the active participation of all team members in the decision-making process. Additionally, efforts should be directed toward narrowing the gap between the conscience of the individual doctor and established ethical principles. A potential solution lies in the nationwide implementation of clinical ethics committees and the establishing of clinical ethics guidelines, aiming to address, and overcome the identified challenges. (shrink)

This paper introduces the medical factual matrix as a new and potentially valuable tool in medical ethical analysis. Using this tool it demonstrates the idea that a defined medical intervention can only be meaningfully declared futile in relation to a defined goal of treatment. It argues that a declaration of futility made solely in relation to a defined medical intervention is inchoate. It recasts the definition of goal futility as an intervention that cannot alter the probability of the (...) existence of the important outcome states that might flow from a defined intervention. The idea of value futility and the extent of physician obligations in futile situations are also addressed. It also examines the source of substantive conflicts which commonly arise within the doctor-patient relationship and the ensuing power relations that operate between doctor and patient when questions of futility arise. (shrink)

This article argues that while the presence and influence of “futility” as a concept in medical decision-making has declined over the past decade, medicine is seeing the rise of a new concept with similar features: suffering. Like futility, suffering may appear to have a consistent meaning, but in actuality, the concept is colloquially invoked to refer to very different experiences. Like “futility,” claims of patient “suffering” have been used (perhaps sometimes consciously, but most often unconsciously) to smuggle (...) value judgments about quality of life into decision-making. And like “futility,” it would behoove us to recognize the need for new, clearer terminology. This article will focus specifically on secondhand claims of patient suffering in pediatrics, but the conclusions could be similarly applied to medical decisions for adults being made by surrogate decision-makers. While I will argue that suffering, like futility, is not sufficient wholesale justification for making unilateral treatment decisions, I will also argue that claims of patient suffering cannot be ignored, and that they almost always deserve some kind of response. In the final section, I offer practical suggestions for how to respond to claims of patient suffering. (shrink)

Futile medical interventions have virtually no chance of success. Doctors might perform such procedures because of pressure from families or patients. The doctor might also have an ulterior motive of gain or prefer to do it rather than take time to communicate with the patient about a poor prognosis. Established ways to communicate bad news to patients are not always used by managing physicians with time constraints. The SPIKES protocol method is outlined to assist in sensitive communication where further intervention (...) is futile. This review primarily explores various aspects of medical futility. It also explores strategies for effectively communicating with patients and their families regarding futility interventions. A side-effect of futile interventions is burnout in doctors and other health practitioners (HPs). The complex relationship between futility and burnout is described. (shrink)

The futility debate may be considered as an effort to provide a clear and justified borderline between physician and patient decision–making authority. In this paper we argue that the search for a definition of futility that provides physicians with a final argument in discussions about life–prolonging treatment, is misplaced. An acceptable and meaningful criterion of futility that satisfies this effort seems impossible. As a consequence, we reject a dichotomous domain of decision–making power as the starting point for (...) definitions of futility. A good decision about withholding life–sustaining treatment should be justified from the perspectives of both physician and patient. In this light, a range of definitions of futility is still useful as it can clarify intuitions that a treatment is inappropriate. (shrink)

Futility is not a purely medical concept. Its subjective nature requires a balanced procedural approach where competing views can be aired and in which disputes can be resolved with procedural fairness. Law should play an important role in this process. Pure medical models of futility are based on a false claim of medical sovereignty. Procedural approaches avoid the problems of such claims. This paper examines the arguments for and against the adoption of a procedural approach to futility (...) determination. (shrink)

“Futility” is a word which means the absence of benefit. It has been used to describe an absence of utility in resuscitation endeavours but it fails to do this. Futility does not consider the harms of resuscitation and we should consider the balance of benefit and harm that results from our resuscitation endeavours. If a resuscitation is futile then any harm that ensues will bring about an unfavourable benefit/harm balance. However, even if the endeavour is not futile, by (...) any definition, the benefit/harm balance may still be unfavourable if the harms that ensue are great.It is unlikely that we will ever achieve a consensus definition of futility and certainly not one that is applicable to every patient undergoing resuscitation. In the meantime our use of the term “futile”, in the mistaken belief that it tells us whether it is worth resuscitating or not, has no utility as it will never succeed in telling us this. Furthermore we risk causing offence by use of the term and we risk harming the patient's autonomy by using futility as an overriding force. Instead we should consider the utility of our endeavours, for which an assessment of the harms of resuscitation should be added to our considerations of its benefit. This balance of benefit and harm should then be evaluated as best it can be from the patient's perspective. The words futile and futility should be abandoned by resuscitationists. (shrink)

BackgroundThe concept of medical futility has exposed the medical staff to many complicated conflicts. Through identifying some of these conflicts, it will be possible to have control over such situations and make plans for managing them better. The present study was conducted to determine the perception of futile care and the reasons behind it among the patients at end-of-life stages from care providers’ perspective.MethodsThis research is an analytical descriptive study which was conducted in Dezful in Iran on 308 care (...) providers including physicians, nurses, and medical and nursing interns, in 2022. The data collection tools included 3 areas: demographic variables, investigating the perception of futile care, and investigating the reasons behind futile care.ResultsThe mean score of perception of futile care was 103.20 ± 32.89 and the mean scores of the reasons behind providing futile care, 118.03 ± 26.09. A significant correlation was observed between the mean scores of the questionnaire for perception of futile care and the reasons behind providing futile care among end-of-life patients (P-value = 0.000, r = 0.465).ConclusionsBased on the findings, almost half of the care providers had a moderate perception of futile care and the reasons behind providing it. The reasons behind providing futile care mentioned by the participants, as well as the positive relationship between the level of perception and the level of education, point out the need for training courses to become more familiar with the concept of futile care and change care providers’ perspectives and attitudes towards end-of-life care. (shrink)

Futility is easily defined as uselessness. The mistaken appearance that it cannot be defined is explained by difficulties applying it to particular cases. This latter problem is a major goal of clinical training and cannot be solved in a pithy statement.

“Futility of futilities,” said Kohelet, “futility of futilities, all is futile!” Once again we are exploring futility, a concept understood by humanity at least from the beginning of the written word. Our oldest written story, the Epic of Gilgamesh, reminds us of the futility of chasing immortality. At least a millennium later, yet still in ancient times, the Book of Kohelet teaches that all human pursuits, not only the pursuit of immortality, are futile or vain—terms once (...) used synonymously. The ancient Greeks introduced an element of punishment into their stories of futility—for example the Danaides sisters were condemned for the murder of their betrothed to use small urns to fill a leaky... (shrink)

Futile treatment is one ethically challenging situation commonly encountered by junior doctors. By analysing an intern's story using a role virtues framework, I propose a set of three steps for junior doctors facing this problem. I claim that junior doctors ought always to investigate the rationale underlying decisions to proceed with apparently futile treatment and discuss their concerns with their seniors, even if such discussion will be difficult. I also suggest that junior doctors facing this ethical challenge ought always to (...) be willing to initiate and engage in ethical dialogue, and that in some situations further action (such as taking concerns outside the team or refusing to participate in treatment) may be morally appropriate. (shrink)

This paper reframes the futility debate, moving away from the question “Who decides when to end what is considered to be a medically inappropriate or futile treatment?” and toward the question “How can society make policy that will best account for the multitude of values and conflicts involved in such decision-making?” It offers a pragmatist moral epistemology that provides us with (1) a clear justification of why it is important to take best standards, norms, and physician judgment seriously and (...) (2) a clear justification of why ample opportunity must be made for patients, families, and society to challenge those standards and norms. (shrink)

Abstract Medical futility is commonly understood as treatment that would not provide for any meaningful benefit for the patient. While the medical facts will help to determine what is medically appropriate, it is often difficult for patients, families, surrogate decision-makers and healthcare providers to navigate these difficult situations. Often communication breaks down between those involved or reaches an impasse. This paper presents a set of practical strategies for dealing with cases of perceived medical futility at a major cancer (...) center. Content Type Journal Article Pages 1-8 DOI 10.1007/s10730-011-9168-3 Authors Colleen M. Gallagher, Section for Integrated Ethics in Cancer Care, Unit 1430, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX 77230-1402, USA Ryan F. Holmes, St. Louis University, St. Louis, MO, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)

Like the authors of some of the other responses to Schneiderman, Jecker, and Jonsen, I too was one of the group that produced “An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Futile and Potentially Inappropriate Treatments in Intensive Care Units”. Furthermore, ethical and legal issues surrounding futile and potentially inappropriate medical treatment have been a primary focus of my scholarship for more than a decade. Schneiderman, Jecker, and Jonsen offer a strong critique of the Multiorganization Statement, but they do (...) not describe it with sufficient precision. There are points of true normative disagreement between the... (shrink)

Debates about medical futility first emerged in the scholarly literature during the 1990s after empirical studies showed the widespread use of medical interventions offering no reasonable chance of...

Why do we persist in the relentless pursuit of artificial nourishment and other treatments to maintain a permanently unconscious existence? In facing the future, if not the present world-wide reality of a huge number of persistent vegetative state (PVS) patients, will they be treated because of our ethical commitment to their humanity, or because of an ethical paralysis in the face of biotechnical progress? The PVS patient is cut off from the normal patterns of human connection and communication, with a (...) life unlike other forms of human existence. Why the struggle to justify ending a life which, it is said, has suffered an irreversible loss of the content of consciousness? Elsewhere, the authors have addressed the ethical controversies and confusion engendered by ambiguous terminology, misuse of medical facts and the differing interpretations of what constitutes 'effective' treatment: in particular, the issue of whether in fact artificial nutrition and hydration is a medical treatment, or simply part of the obligatory care owed to all patients, permanently unconscious or not. In this paper, we intend to argue that recent analyses of medical futility, its meaning and ethical implications, despite an absence of public consensus, permit some tentative re-evaluation of our ethical obligations to the PVS patient. (shrink)

In this interview with Thomas Dekeyser, Eugene Thacker elaborates on the central themes of his work. Addressing themes including extinction, futility, human universalism, network euphoria, political indecision and scientific nihilism, the interview positions Thacker’s work within the contemporary theoretical conjuncture, specifically through its relation to genres of thought his work is often grouped with or cast against: vitalism, speculative realism and accelerationism. More broadly, however, the interview offers a unique insight into Thacker’s approach to the thinking, doing and writing (...) of ‘philosophy’. (shrink)