Bioethics Discussion Blog: Is it Futile to Attempt to Define Medical Futility?

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Tuesday, October 10, 2006

Is it Futile to Attempt to Define Medical Futility?

From my now inactive "Bioethics Discussion Pages" is a topic I first posted in 2001 but the question of what is and who defines medical futility is still being debated.
In fact, there is a view that the use of the words "medical futility" be abandoned. The visitors to my "Pages" expressed their views on the subject below (most recent at the top). What is your definition of the words and who should determine what is futile and what isn't? ..Maurice.



Current medical science and technology has given physicians new tools to treat diseases and to keep patients alive for longer periods of time than would be possible in the past. However, there are times in the management of the patient's illness when the physician finds that further energetic diagnostic test or treatment to attempt to treat the disease or try to prolong life would be futile. A treatment might not be expected to work or an expected outcome would be unlikely, particularly if the resultant quality of life would be considered poor. The treatment might, instead of prolonging life, only prolong a difficult dying. But there is still controversy amongst physicians and amongst patients along with their families as to what futile means and when a procedure or treatment can be called futile. Physicians may find one treatment approach futile but the patient or family member may disagree and deny futility. Occasionally the opposite occurs with the physician resisting discontinuing a treatment. What is needed is some consensus between physicians and the public as to what establishes a determination of futility.

Here is the question:
What represents futililty in medical practice? Under what conditions, if any, is medical treatment futile? Who should decide?

---- THE DISCUSSIONS ----

Date: Sat, May 8, 2004 10:17 AM From: anthonye@telusplanet.net To: DoktorMo@aol.com

Since death is inevitable, it should not be a consideration in dealing with an illness that might inevitably lead to death. The only consideration should be the comfort and dignity of the patient, allowing death or a cure to arise according to the will to fight of the patient, not the family or the doctor. Sincerely, Anthony Edgington. HSA life member.
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Date: Tue, Apr 1, 2003 9:52 AM From: genkkov@hotmail.com To: DoktorMo@aol.com

From the Aphorisms, "What diet cannot cure, drugs will. What drugs will not cure, the knife will. What the knife will not cure, fire will. What fire will not cure must be considered incurable." Medicine has always had limitations as to what it can and cannot accomplish, and though we can cure many things today that the ancients could not even dream of, despite all of our technology and knowledge, man is still mortal. Even if there is an extremely radical cure for a certain disease, as surgery and cautery certainly were in the ancient world one must consider the patient's chances of success if they receive the treatment, and the quality of life that they will experience post treatment. It is the patient's decision; of course, in the end, but as a physician one must give the patient an honest assessment upon which he can predicate his decision. Euthanasia is derived from the Greek, "good death". The good physician realizes when the limit of technology has been reached, that further attempts to save life are futile, and at that time the role of the physician changes from trying to save or prolong life, to trying to provide the best possible life for the patient in those days that remain. By no means should this be looked upon as abandoning the patient, but rather giving the patient an opportunity to die at ease with himself and the world, rather like Socrates drinking the hemlock and dying surrounded by his students and friends, at peace with his life and his mortality.
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Date: Mon, Mar 31, 2003 7:51 PM From: battaryacid@hotmail.com To: DoktorMo@aol.com

What represents futililty in medical practice? Under what conditions, if any, is medical treatment futile? Who should decide?

I think that it is important for doctors and patients alike to remember that doctors are just people doing the best they can to help. The power a doctor seems to have over a patient's well-being and life gives him a god-like status to the patient, but it is important to remember that doctors have no mythical powers; only study, preparation, skill, and perhaps intelligence separates the doctor from the patient.

It is important to remember that in the ancient days, there was no way to certify doctors and make sure that their medical skills were effective at all. We should be thankful that there is schooling for doctors today so we can have some idea as to whether or not they will be effective, but still it is important to remember that doctors are not gods. In ancient days in Greece and Rome sometimes doctors would combine their practice with religion, claiming to cure people by the power vested in them by the gods.

Many advancements have been made in medicine since ancient times and modern medical practices have deleted a good deal of the inneffective methods of old cures, but human beings are still made the same today as they have always been and all humans must be obedient to the laws of science.
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Date: Mon, Jul 23, 2001 12:40 PM From: Mikerau99@aol.com To: DoktorMo@aol.com

There are scenarios where treatment is futile. Quality of life is a major factor in determining whether an individual with no prospects of achieving or regaining a minimal quality of life should continue to receive medical interventions that will do nothing more than mandate a marginal existence. While the issue of what level of quality should be left to the patient or the patient's surrogate, there are levels where medical professionals providing the care should be able and willing to say "no" to requests for additional care. When you have had to watch a family "pray for a miracle" while the medical staff is asked to provide care that they recognize is futile, there is a duty to act on behalf of the staff caring for that patient. Ignoring the economic issues, the emotional impact on the providers of having to continue to provide care, having to provide CPR on a patient having to use drugs to maintain the blood pressure to maintain a body that is so marginal is immoral. The medical profession must make those decisions.

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Date: Fri, Jun 1, 2001 6:42 PM From: shackett@qwest.net To: DoktorMo@aol.com

Futile medicine promotes death. If the person wants the treatment the doctor can refuse to give by reason the medicine is futile. If the patient chooses to die its okay for that. I think futile medicine theory is a bad one.

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Date: Sat, May 19, 2001 7:40 PM From: kmohmd@link.net.id To: DoktorMo@aol.com

Up to this day, to my opinion, there is no way to determine criteria on "medical futility" since it encompasses many different fields. A.o. Family's expectation (which is inflenced by level of education, culture, and beliefs), economic factors, and medical statistics. So to stop any "futile" medical treatment must be decided individually. This is part of "the art" of bioethics.

4 Comments:

At Wednesday, October 11, 2006 8:30:00 AM, Anonymous bob koepp said...

A procedure is futile if it cannot be reasonably expected to produce its intended effects. That's not a difficult notion to grasp, even if there will always be room for debate about what counts as a "reasonable expectation."

The more difficult question is what sorts of intended effects are, properly speaking, medical. I'd argue for a relatively narrow construal of the proper aim of medical practice, focused on positively influencing the health status of individual patients.

 
At Sunday, November 05, 2006 10:54:00 PM, Blogger Maurice Bernstein, M.D. said...

Bob,the question is what is "reasonably expected"? Is it, as ethicist-physician Larry Schneiderman set the criterion of 1 chance out of 100; that is, any treatment more rare than 1 intended effect out of 100 attempts would be considered futile? And what if the result of treatment is not what was intended but provided some unintended benefit? For example, if a drug, did not perform it's intended function and did not resolve the illness or prevent death, but simply briefly delayed the death, prolonged the dying, which allowed some additional time, which might have been a beneficent occurance for the patient or the family, would the administration of that drug be considered futile treatment? It didn't produce it's indended effect but it produced an unintended and unexpected beneficial effect. Sometimes we use words as if they were exact grammatical landmarks, setting limits to what we intend to do, such as in the case of the word "futile" but then discover that we really don't understand what the words mean. ..Maurice.

 
At Saturday, December 30, 2006 12:51:00 PM, Anonymous Moof said...

Dr. Bernstein, I agree with you about treating words like "exact grammatical landmarks" ... all they really can be, when you're talking about the human condition in general, and medicine in particular, is a directional inference.

I don't believe that treatment that prolongs a person's life is futile if the patient wanted it to be prolonged ... that doesn't speak to the quality of the prolonged life, either - just the fact that it was lengthened.

"Futility" seems to have quite a few possible modifiers ...

Excellent question, Dr. Bernstein ...

 
At Monday, January 22, 2007 8:33:00 AM, Anonymous Anonymous said...

"only study, preparation, skill, and perhaps intelligence separates the doctor from the patient"


Perhaps intelligence???

 

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