Futility: Is Definition the Problem? Part I
Cotler, Miriam Piven
Rasinsky Gregory, Dorothy
Cambridge Quarterly of Healthcare Ethics. 1993 Spring; 2(2): 219-224.
A physician recently asked how to respond in the case of an 87-year-old patient with advanced Alzheimer's disease, who was unable to swallow or tolerate a nasogastric tube, when the family insisted a gastrostomy tube be inserted but the physician believed the intervention futile. That question encompasses some of the crucial issues in the concept of futility of the treatment goals of physician, patient, and family; the rights of patients and families to demand care; physician judgment; family values; and, to the degree that it represents many similar dilemmas, justice. What are professionals saying when they pronounce treatment futile? What are patients' rights if they or their surrogates disagree? The word "futile" implies a precision about outcome probability that we do not have, and it ignores the wide range of treatments for a given diagnosis. Is futile the same as useless or the opposite of hope? Futile for what? Cure? Restoration of function? Prolongation of life? Relief from pain? Relief from anxiety? Comfort? Reassurance? To satisfy or placate the patient or the family? The word "futile" is so imprecise that, rather than clarifying, it confuses and clutters the discussion.
Allowing to Die; Autonomy; Decision Making; Diagnosis; Disclosure; Disease; Futility; Goals; Justice; Life; Moral Obligations; Pain; Paternalism; Patients; Patients' Rights; Physician Patient Relationship; Physicians; Probability; Prolongation of Life; Quality of Life; Resource Allocation; Rights; Risks and Benefits; Terminally Ill; Terminology; Values; Withholding Treatment;