futility

Introduction

Unilateral decision by the physician to withhold or withdraw medical interventions, based on predictable futile outcome.

Cannot achieve patient goals

Care does not meet goals of medicine

Care has too remote a chance for success (i.e. < 1%) to be useful.

Situations where the 'futility' is considered

• denial or misperception of reality by the patient, surrogate or physician
• surrogate is willing to accept a quality of life which the patient would never have accepted
• surrogates with psychological decisional incapacity

Futility situations are usually the result of suboptimal practice of clinical ethics

• missed opprtunities to elicit patient preferences prior to incapacity
• poor administration of patient's prior preferences or advance directives
• inability to define the appropriate decision maker
• poor understanding or handling of surrogate's emotional suffering
• physician's presentation of therapeutic options is suboptimal
  • optimistic bias - physicians tend to overestimate patient's survival duration
  • inadequate communication of risks & outcomes of maximally aggressive care, or of alternatives to it

Additional terms

• medical ethics