Physicians' Quantitative Assessments of Medical Futility

Abstract

We believe that data indicating the level of agreement among physicians on the issue of futility will advance the debate regarding the appropriateness of physicians' acting as unilateral arbiters of futility. Therefore, we undertook this study to explore the following questions. Do physicians generalize a quantitative probability of successful treatment as a cutoff point that defines futility across a population of terminally ill patients and a variety of possible medical interventions? If so, what is the range of probabilities selected by physicians in this regard? Further, what is the level of agreement among physicians regarding the acceptable cutoff point for defining when treatment is futile for terminally ill patients? We expected that there would be wide variation in physicians' general assessments of what constitutes medical futility, for three reasons. First, to the extent that physicians generalize from specific memorable cases, their assessments of futility cutoff points will be influenced by medical indications and treatments that vary according to the particular cases remembered. Second, even if all physicians were able to develop a position on futility based on their knowledge and understanding of one common case, it is unlikely that they would all agree on a specific prognosis and plan of treatment in that case. Third, variations in physicians' responses may reflect divergent judgments regarding the value and quality of particular patients' lives. Our data confirmed our expectations of a wide variation and lack of agreement among physicians. We present our findings and discuss their implications for clinical decision making and for future directions in theory and research.