Futility and the obligations of physicians

Bioethics

Volumn 10, Issue 1, 1996, Pages 43-55

  Wilson, Bradley E ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; ANALYTICAL APPROACH; ANENCEPHALUS; ARTICLE; CASE REPORT; CRITICAL ILLNESS; DEATH AND EUTHANASIA; DECISION MAKING; ETHICS; FAMILY; HUMAN; INTERPERSONAL COMMUNICATION; MEDICINE; MOTIVATION; NEWBORN; NOMENCLATURE; PASSIVE EUTHANASIA; PATIENT; PATIENT CARE; PHYSICIAN; QUALITY OF LIFE; RESUSCITATION; RISK; RISK ASSESSMENT; SOCIAL PSYCHOLOGY; SOCIOECONOMICS; TREATMENT OUTCOME; TREATMENT WITHDRAWAL; VENTILATOR;

ANALYTICAL APPROACH; DEATH AND EUTHANASIA;

ADULT; ANENCEPHALY; COMMUNICATION; CRITICAL ILLNESS; DECISION MAKING; ETHICS; EUTHANASIA, PASSIVE; FAMILY; GOALS; HUMANS; INFANT, NEWBORN; MEDICAL FUTILITY; MEDICINE; PATIENT CARE; PATIENTS; PHYSICIANS; QUALITY OF LIFE; RESUSCITATION; RESUSCITATION ORDERS; RISK; RISK ASSESSMENT; SOCIAL VALUES; TERMINOLOGY; VALUE OF LIFE; VENTILATORS, MECHANICAL; WITHHOLDING TREATMENT;

EID: 0029692992     PISSN: 02699702     EISSN: None     Source Type: Journal    
DOI: 10.1111/j.1467-8519.1996.tb00102.x     Document Type: Article

References (40)

1. The debate about the concept of futility and its role in clinical decision making seems to be restricted to the United States. This may be because of the current emphasis in the United States on reducing the costs of medical care, since futility determinations can be used to deny or not offer expensive treatment at the end of life. I am indebted to John C. Fletcher for help in clarifying this point.
2. See L.J. Blackhall, 'Must We Always Use CPR?' New England Journal of Medicine 317, 1987, 1281-5; T. Tomlinson and H. Brody, 'Ethics and Communication in DoNot-Resuscitate Orders', New England Journal of Medicine 318, 1988, 43-6; S.J. Youngner, 'Who Defines Futility?' Journal of the American Medical Association 260, 1988, 2094-5; D.L. Schiedermayer, 'The Decision to Forgo CPR in the Elderly Patient', Journal of the American Medical Association 260, 1988, 2096-7; D.J. Murphy, 'Do-Not-Resuscitate Orders: Time for Reappraisal in Long-Term-Care Institutions', Journal of the American Medical Association 260, 1988, 2098-101; T. Tomlinson and H. Brody, 'Futility and the Ethics of Resuscitation', Journal of the American Medical Association 264, 1990, 1276-1280; J.C. Hackler and F.C. Hiller, 'Family Consent to Orders Not to Resuscitate: Reconsidering Hospital Policy', Journal of the American Medical Association 264, 1990, 1281-3; S.J. Youngner, 'Futility in Context', Journal of the American Medical Association 264, 1990, 1295-6.
3. See L.J. Blackhall, 'Must We Always Use CPR?' New England Journal of Medicine 317, 1987, 1281-5; T. Tomlinson and H. Brody, 'Ethics and Communication in DoNot-Resuscitate Orders', New England Journal of Medicine 318, 1988, 43-6; S.J. Youngner, 'Who Defines Futility?' Journal of the American Medical Association 260, 1988, 2094-5; D.L. Schiedermayer, 'The Decision to Forgo CPR in the Elderly Patient', Journal of the American Medical Association 260, 1988, 2096-7; D.J. Murphy, 'Do-Not-Resuscitate Orders: Time for Reappraisal in Long-Term-Care Institutions', Journal of the American Medical Association 260, 1988, 2098-101; T. Tomlinson and H. Brody, 'Futility and the Ethics of Resuscitation', Journal of the American Medical Association 264, 1990, 1276-1280; J.C. Hackler and F.C. Hiller, 'Family Consent to Orders Not to Resuscitate: Reconsidering Hospital Policy', Journal of the American Medical Association 264, 1990, 1281-3; S.J. Youngner, 'Futility in Context', Journal of the American Medical Association 264, 1990, 1295-6.
4. See L.J. Blackhall, 'Must We Always Use CPR?' New England Journal of Medicine 317, 1987, 1281-5; T. Tomlinson and H. Brody, 'Ethics and Communication in DoNot-Resuscitate Orders', New England Journal of Medicine 318, 1988, 43-6; S.J. Youngner, 'Who Defines Futility?' Journal of the American Medical Association 260, 1988, 2094-5; D.L. Schiedermayer, 'The Decision to Forgo CPR in the Elderly Patient', Journal of the American Medical Association 260, 1988, 2096-7; D.J. Murphy, 'Do-Not-Resuscitate Orders: Time for Reappraisal in Long-Term-Care Institutions', Journal of the American Medical Association 260, 1988, 2098-101; T. Tomlinson and H. Brody, 'Futility and the Ethics of Resuscitation', Journal of the American Medical Association 264, 1990, 1276-1280; J.C. Hackler and F.C. Hiller, 'Family Consent to Orders Not to Resuscitate: Reconsidering Hospital Policy', Journal of the American Medical Association 264, 1990, 1281-3; S.J. Youngner, 'Futility in Context', Journal of the American Medical Association 264, 1990, 1295-6.
5. See L.J. Blackhall, 'Must We Always Use CPR?' New England Journal of Medicine 317, 1987, 1281-5; T. Tomlinson and H. Brody, 'Ethics and Communication in DoNot-Resuscitate Orders', New England Journal of Medicine 318, 1988, 43-6; S.J. Youngner, 'Who Defines Futility?' Journal of the American Medical Association 260, 1988, 2094-5; D.L. Schiedermayer, 'The Decision to Forgo CPR in the Elderly Patient', Journal of the American Medical Association 260, 1988, 2096-7; D.J. Murphy, 'Do-Not-Resuscitate Orders: Time for Reappraisal in Long-Term-Care Institutions', Journal of the American Medical Association 260, 1988, 2098-101; T. Tomlinson and H. Brody, 'Futility and the Ethics of Resuscitation', Journal of the American Medical Association 264, 1990, 1276-1280; J.C. Hackler and F.C. Hiller, 'Family Consent to Orders Not to Resuscitate: Reconsidering Hospital Policy', Journal of the American Medical Association 264, 1990, 1281-3; S.J. Youngner, 'Futility in Context', Journal of the American Medical Association 264, 1990, 1295-6.
6. See L.J. Blackhall, 'Must We Always Use CPR?' New England Journal of Medicine 317, 1987, 1281-5; T. Tomlinson and H. Brody, 'Ethics and Communication in DoNot-Resuscitate Orders', New England Journal of Medicine 318, 1988, 43-6; S.J. Youngner, 'Who Defines Futility?' Journal of the American Medical Association 260, 1988, 2094-5; D.L. Schiedermayer, 'The Decision to Forgo CPR in the Elderly Patient', Journal of the American Medical Association 260, 1988, 2096-7; D.J. Murphy, 'Do-Not-Resuscitate Orders: Time for Reappraisal in Long-Term-Care Institutions', Journal of the American Medical Association 260, 1988, 2098-101; T. Tomlinson and H. Brody, 'Futility and the Ethics of Resuscitation', Journal of the American Medical Association 264, 1990, 1276-1280; J.C. Hackler and F.C. Hiller, 'Family Consent to Orders Not to Resuscitate: Reconsidering Hospital Policy', Journal of the American Medical Association 264, 1990, 1281-3; S.J. Youngner, 'Futility in Context', Journal of the American Medical Association 264, 1990, 1295-6.
7. See L.J. Blackhall, 'Must We Always Use CPR?' New England Journal of Medicine 317, 1987, 1281-5; T. Tomlinson and H. Brody, 'Ethics and Communication in DoNot-Resuscitate Orders', New England Journal of Medicine 318, 1988, 43-6; S.J. Youngner, 'Who Defines Futility?' Journal of the American Medical Association 260, 1988, 2094-5; D.L. Schiedermayer, 'The Decision to Forgo CPR in the Elderly Patient', Journal of the American Medical Association 260, 1988, 2096-7; D.J. Murphy, 'Do-Not-Resuscitate Orders: Time for Reappraisal in Long-Term-Care Institutions', Journal of the American Medical Association 260, 1988, 2098-101; T. Tomlinson and H. Brody, 'Futility and the Ethics of Resuscitation', Journal of the American Medical Association 264, 1990, 1276-1280; J.C. Hackler and F.C. Hiller, 'Family Consent to Orders Not to Resuscitate: Reconsidering Hospital Policy', Journal of the American Medical Association 264, 1990, 1281-3; S.J. Youngner, 'Futility in Context', Journal of the American Medical Association 264, 1990, 1295-6.
8. See L.J. Blackhall, 'Must We Always Use CPR?' New England Journal of Medicine 317, 1987, 1281-5; T. Tomlinson and H. Brody, 'Ethics and Communication in DoNot-Resuscitate Orders', New England Journal of Medicine 318, 1988, 43-6; S.J. Youngner, 'Who Defines Futility?' Journal of the American Medical Association 260, 1988, 2094-5; D.L. Schiedermayer, 'The Decision to Forgo CPR in the Elderly Patient', Journal of the American Medical Association 260, 1988, 2096-7; D.J. Murphy, 'Do-Not-Resuscitate Orders: Time for Reappraisal in Long-Term-Care Institutions', Journal of the American Medical Association 260, 1988, 2098-101; T. Tomlinson and H. Brody, 'Futility and the Ethics of Resuscitation', Journal of the American Medical Association 264, 1990, 1276-1280; J.C. Hackler and F.C. Hiller, 'Family Consent to Orders Not to Resuscitate: Reconsidering Hospital Policy', Journal of the American Medical Association 264, 1990, 1281-3; S.J. Youngner, 'Futility in Context', Journal of the American Medical Association 264, 1990, 1295-6.
9. See L.J. Blackhall, 'Must We Always Use CPR?' New England Journal of Medicine 317, 1987, 1281-5; T. Tomlinson and H. Brody, 'Ethics and Communication in DoNot-Resuscitate Orders', New England Journal of Medicine 318, 1988, 43-6; S.J. Youngner, 'Who Defines Futility?' Journal of the American Medical Association 260, 1988, 2094-5; D.L. Schiedermayer, 'The Decision to Forgo CPR in the Elderly Patient', Journal of the American Medical Association 260, 1988, 2096-7; D.J. Murphy, 'Do-Not-Resuscitate Orders: Time for Reappraisal in Long-Term-Care Institutions', Journal of the American Medical Association 260, 1988, 2098-101; T. Tomlinson and H. Brody, 'Futility and the Ethics of Resuscitation', Journal of the American Medical Association 264, 1990, 1276-1280; J.C. Hackler and F.C. Hiller, 'Family Consent to Orders Not to Resuscitate: Reconsidering Hospital Policy', Journal of the American Medical Association 264, 1990, 1281-3; S.J. Youngner, 'Futility in Context', Journal of the American Medical Association 264, 1990, 1295-6.
10. L.J. Schneiderman, N.S. Jecker, and A.R. Jonsen, 'Medical Futility: Its Meaning and Ethical Implications', Annals of Internal Medicine 112, 1990, 949-54.
11. L.J. Schneiderman, N.S. Jecker and A.R. Jonsen, ibid., p. 951, go on to suggest a definition of 'futility' and 'futile' that is based on the probability of achieving a result; they want to use these terms 'to describe any effort to achieve a result that is possible but that reasoning or experience suggests is highly improbable and that cannot be systematically produced'. I will discuss the role of probability in futility determinations below.
12. S. Youngner, 1988, op. cit., note 1, p. 2094.
13. J.D. Lantos, et al., 'The Illusion of Futility in Clinical Practice', American Journal of Medicine 87, 1989, p. 83.
14. J.C. Hackler and F.C. Hiller, op. cit., note 1, p. 1282.
15. L.J. Schneiderman, N.S. Jecker and A.R. Jonsen, op. cit., note 2, p. 950.
16. R.D. Truog, A.S. Brett, and J. Frader, 'The Problem With Futility', New England Journal of Medicine 326, 1992, p. 1561.
17. See, for example, S. Youngner, 1988, op. cit., note 1; T. Tomlinson and H. Brody, 1990, op. cit., note 1; R.D. Truog, A.S. Brett, and J. Frader, ibid.
18. See, for example, S. Youngner, 1988, op. cit., note 1; T. Tomlinson and H. Brody, 1990, op. cit., note 1; R.D. Truog, A.S. Brett, and J. Frader, ibid.
19. See, for example, S. Youngner, 1988, op. cit., note 1; T. Tomlinson and H. Brody, 1990, op. cit., note 1; R.D. Truog, A.S. Brett, and J. Frader, ibid.
20. See, for example, T. Tomlinson and H. Brody, 1990, op. cit., note 1, p. 1278.
21. See, for example, R.D. Truog, A.S. Brett, and J. Frader, op. cit., note 8, p. 1563.
22. See, for example, L.J. Schneiderman, N.S. Jecker and A.R. Jonsen, op. cit., note 2, p. 952.
23. In this case, it would probably be necessary to reconsider the goals of treatment if the patient experienced a cardiac arrest. However, I think my general point still holds: value judgments based on probabilities will not be sufficient for establishing that treatment is futile according to the characterization given earlier.
24. T. Tomlinson and H. Brody, 1990, op. cit., note 1, p. 1278.
25. Ibid., p. 1278.
26. Ibid., p. 1278.
27. See, for example, S. Youngner, 1988, op. cit., note 1; R.D. Truog, A.S. Brett, and J. Frader, op. cit., note 8.
28. See, for example, S. Youngner, 1988, op. cit., note 1; R.D. Truog, A.S. Brett, and J. Frader, op. cit., note 8.
29. Ibid., p. 1563.
30. Ibid., p. 1561.
31. See, for example, L.J. Blackhall, op. cit., note 1; D. J. Murphy, op. cit., note 1; J.C. Hackler and F.C. Hiller, op. cit., note 1; L.J. Schneiderman, N.S. Jecker and A.R. Jonsen, op. cit., note 2.
32. See, for example, L.J. Blackhall, op. cit., note 1; D. J. Murphy, op. cit., note 1; J.C. Hackler and F.C. Hiller, op. cit., note 1; L.J. Schneiderman, N.S. Jecker and A.R. Jonsen, op. cit., note 2.
33. See, for example, L.J. Blackhall, op. cit., note 1; D. J. Murphy, op. cit., note 1; J.C. Hackler and F.C. Hiller, op. cit., note 1; L.J. Schneiderman, N.S. Jecker and A.R. Jonsen, op. cit., note 2.
34. See, for example, L.J. Blackhall, op. cit., note 1; D. J. Murphy, op. cit., note 1; J.C. Hackler and F.C. Hiller, op. cit., note 1; L.J. Schneiderman, N.S. Jecker and A.R. Jonsen, op. cit., note 2.
35. See, for example, T. Tomlinson and H. Brody, 1988, op. cit., note 1; T. Tomlinson and H. Brody, 1990, op. cit., note 1; S. Youngner, 1990, op. cit., note 1.
36. See, for example, T. Tomlinson and H. Brody, 1988, op. cit., note 1; T. Tomlinson and H. Brody, 1990, op. cit., note 1; S. Youngner, 1990, op. cit., note 1.
37. See, for example, T. Tomlinson and H. Brody, 1988, op. cit., note 1; T. Tomlinson and H. Brody, 1990, op. cit., note 1; S. Youngner, 1990, op. cit., note 1.
38. See, for example, J.D. Lantos et al., op. cit., note 5; R.D. Truog, A.S. Brett, and J. Frader, op. cit., note 8.
39. See, for example, J.D. Lantos et al., op. cit., note 5; R.D. Truog, A.S. Brett, and J. Frader, op. cit., note 8.
40. J.D. Lantos et al., op. cit., note 5, p. 81.