Futility in Practice
Schneiderman, Lawrence J.
Archives of Internal Medicine. 1993 Feb 22; 153(4): 437-441.
...Much of the resistance to the notion of futility, we believe, derives from the fear that it will serve as a masquerade for less defensible motivations. For example, will its acceptance revive discarded abuses of medical paternalism? Will it reverse recent advances in patient autonomy and shared decision making? Will the power to declare treatment futile provide a convenient excuse for physicians to neglect patients they deem unworthy? Will it entice nervous health care providers to avoid patients with life-threatening contagious illness? Will futility serve as a devious rationale for reducing medical costs? We acknowledge these potential corruptions of the concept, yet we would argue that they are more likely to occur under the present state of ambiguity. In our view, only by seeking to develop a rigorous definition of futility will we encourage clarity of thinking with regard to the larger ethical problem of withholding and withdrawing medical treatment. It is particularly important, for example, to distinguish futility (implying no apparent therapeutic benefit) from rationing (acknowledging therapeutic benefit but raising questions about cost-worthiness). In our experience, rationing is the notion most often confused with futility. Just as physicians find it painful to admit to a patient or family that they have run out of beneficial treatments, so too they find it difficult to upset egalitarian ideals by selectively apportioning such treatments.
Aids; Allowing to Die; Alternative Therapies; Autonomy; Cancer; Case Studies; Consensus; Decision Making; Dementia; Family Members; Futility; Health; Health Care; Human Experimentation; Illness; Life; Paternalism; Patient Care; Patients; Physicians; Prognosis; Prolongation of Life; Power; Quality of Life; Resource Allocation; Resuscitation; Resuscitation Orders; Risks and Benefits; Standards; Terminology; Values; Withholding Treatment;
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