The Language of Bioethics: Nuances in Use Lead to Ethical Dilemmas
In contrast to the “Thai Dictionary of Medical Ethics” which appears to be a “tongue-in-cheek” description of terms used in bioethics, for those who would like the more established definitions, I suggest you go to this link which is to the “Language of Bioethics” by the Medical College of Georgia. Many terms are tossed around these days by doctors, ethicists, politicians and others and it is worthwhile to understand what is the current consensus of meaning of the terms.
Futility is a word often used but often misused since in medical practice using the word futility or futile alone is misleading. That is because one has to describe in what sense the term futile or futility is being used. Often the expression is used: “further treatment is futile”. It is this misuse that has caused some ethicists to declare that this term should not be used as a medical descriptor. So, from the “Language of Bioethics” what should we know about the term “futility”?
Futility: a term dealing with the hopelessly ill and dying; at least three meanings bear consideration:
Physiologic futility–the proposed intervention or continued treatment cannot reverse a physiologic condition in the patient that is leading to death. This strict definition of futility means that the intended medical effect of the treatment is not likely to occur, as determined by scientific evidence or local medical experience.
Personal futility–the proposed intervention or continued treatment may have the desired medical effect, but the resulting benefit does not outweigh the burden of continued life. This "best interest" or "disproportionate burden" definition of futility may mean that consciousness of the patient is not restored, or he/she will not leave the ICU, or that severe suffering will persist.
Social futility–the proposed intervention or continued treatment may have the desired medical effect, and personal benefit may outweigh the burden, but the treatment is not available, as determined by the social consensus, due to scarce resources.
A question one may want to ask is which kind of futility should ethically trump the others? If a treatment does what it is supposed to do with regard to symptoms but doesn’t make the patient better in terms of extending a life that the patient desires, should that treatment be called futile and not started or discontinued? What if the treatment would save a life such as a ventilator for a critically ill elderly patient but in this catastrophic influenza pandemic, the last ventilator available at the time was instead could be used on a young critically ill patient. In that case, socially established triage criteria found that the ventilator, under these circumstances, was a socially futile treatment for that elderly patient since it prevented recovery of one much younger and perhaps, when recovered, make a longer contribution to the benefit of society. Should the possibility of social futility trump all? Or if there is no physiologic nor personal futility in the treatment then “first come, first served” should be the principle used when resources are scarce?
Look at the list for all the other bioethics terms in the “Language of Bioethics”. Unfortunately, despite clear definitions to these terms, nuances in their use add to potential ethical dilemmas. (As that list defines Dilemma: moral obligations to others exist on both sides of the choice; ethical reasons that support choosing both alternatives.) I may delve into other terms in later posts in which their meanings don’t always set clear ethical answers. ..Maurice.
Addendum: By the way, the criteria for "Personal Futility" should be set by the patient or if the patient cannot communicate and there is no surrogate to tell what is known about the patient's wishes, physicians must use the "Reasonable Person Standard" which is what a "reasonable person" would decide about their future quality of life.