Futility in Practice

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Abstract
ALTHOUGH THE termfutilityis actively used in medical discourse, critics object to the concept, calling it "elusive,"1"unsettling" (Am Med News. November 11, 1991:28),"dangerous,"2and devoid of a "clear sense of public values."3If such objections prevail, they will effectively undermine assertions made by a wide variety of authorities that physicians are not obligated to provide futile treatment.4-8Must futility be construed only as an ambiguous concept, cited in the abstract, or can it be defined with sufficient specificity to be useful in clinical practice? 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