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Futility: Is Definition the Problem? Part I

Published online by Cambridge University Press:  29 July 2009

Miriam Piven Cotler  and
Dorothy Rasinski Gregory
Miriam Piven Cotler
Affiliation:
Department of Health Service, California State University, Northridge
Dorothy Rasinski Gregory
Affiliation:
Center for Health-care Ethics, St. Joseph Health System, Orange, California
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Extract

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? Restora tion of function? Prolongation of life? Relief from pain? Relief from anxiety? Com fort? 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.

Type
Special Section: Medical Futility: Demands, Duties, and Dilemmas
Information
Cambridge Quarterly of Healthcare Ethics , Volume 2 , Issue 2 , Spring 1993 , pp. 219 - 224
Copyright
Copyright © Cambridge University Press 1993

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References

Notes

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