Stephen N. Nelson, "Do Everything!--Encountering Futility in Medical Practice.

• Position: Abstracts

19 ETHICS & MED. 103 (2003).

Contemporary medicine is a two-edged sword: its powerful technology can be an agent in great healing or in great harm. The dark side of modern medicine can prolong the dying process, adversely impacting one's quality of life and unjustly squander health care resources. With the recent advent of the legal and ethical primacy of patient autonomy, patients have become emboldened not only to refuse unwanted medical interventions but also to demand potentially useless and harmful therapy. Often, physicians have unilaterally refused to provide such therapy on the basis of "medical futility," the definition of which has proven elusive.

Futility connotes the idea that the proposed therapy is wasteful, pointless, and ineffective. Furthermore, futile therapy is unlikely to achieve the intended goal or to be of benefit. However, the words "wasteful," "pointless," "ineffective," "helpful," "beneficial," and "effective" are all subjective and relative terms that are context-dependent and value-laden. As a result, there has been a concerted effort by many ethicists to create a clinically useful taxonomy of futility at its "quantitative and qualitative roots." "Quantitative futility" suggests that futility, representing the unlikely chance a benefit will be realized, can be defined at a certain statistical threshold. For example, a medical therapy may be considered...