What is the Definition of Medical Futility?

Question

Answer

• To a reasonable degree of medical certainty, it is not possible for the intervention to act as a bridge to:
• Prevent/reduce the deterioration of the health of an individual
• Prevent the impending death
• Effectively or appreciably alter the course of the disease
• Futile treatment is identified as treatment that is burdensome harmful to the patient

Let's start with defining futility. This is difficult for many reasons. There has been a lot of conversation about whether or not we even need to use the word futility or futile. It is a confusing concept, especially for those of us who may not engage in these types of conversations on a regular basis. Medically futile treatment means that to a reasonable degree of medical certainty, it is not possible for the intervention to act as a bridge to prevent or reduce the deterioration of an individual's health, prevent the impending death, or effectively or appreciably alter the course of the disease. Futile treatment is identified as a treatment that is burdensome and harmful to the patient. We can accept that chemotherapy is a beneficial treatment for cancer. Can we also accept that it can be a futile, burdensome medical procedure? Defining futility is different and difficult.

This particular group of researchers, Jox et al., about 10 years ago, evaluated ethics consultations in Germany and interviewed 18 physicians and 11 nurses engaged in those procedures. This was both in the critical care environment and in palliative care. Their point was that they wanted to understand the perceptions of futility. They found four main categories through their interviews regarding the definition of medical futility, 

• Pointless, not reasonable (8)
• No goal of care attainable (29)
• Burden benefit (20)
• Has to be defined with regard to the individual patient, holistically (3) (Jox et al, 2012)

We see that the main themes include pointless or not reasonable interventions and no attainable goal of care. The burdens were greater than the benefits for each of the interventions that were proposed, so the necessity of individualizing the definition. If we have difficulties defining futile interventions, then it makes sense that we will have difficulties applying them.

This Ask the Expert is an edited excerpt from the course, Futile or Fruitful: Medical Interventions and the Respiratory Therapist, presented by Shawna Strickland, Ph.D., CAE, RRT, RRT-NPS, RRT-ACCS, AE-C, FAARC.