Perspectives in Biology and Medicine

This article offers a comparative perspective of the controversy about the use of the term futility as presented by Schneiderman and colleagues (2017). The English concept of “medical futility” has no semantic equivalent in the French language. The traditional term used to translate it was “therapeutic obstinacy,” which changed to “unreasonable obstinacy” when the first end-of-life law was adopted in 2005. The change was done in order to demedicalize the concept and make it less objective and less scientific. As such, the intention of the French legislature may have been equivalent to the intention behind the recent U.S. policy statement that proposed replacing the term futile with inappropriate (Bosslet et al. 2015). The semantic change towards “unreasonable obstinacy” pushed practitioners in France to the same conclusion formalized some years ago by Helft and colleagues (2000), who said that pronouncing the term futility can’t be enough by itself to convince patients or their proxies that the treatments should be ceased. Instead, it should initiate the difficult task of negotiating until they will accept that there is no other issue for the patient but the withdrawal of all aggressive and invasive treatments. The best way to enter this cruel negotiation remains unresolved. Is it in using the term futility, which involves a notion of medical undisputable objectivity, as well as an ending dimension that is difficult for people to be confronted with? Or is it in choosing a less definitive word, which leaves room for something else to happen and to be positively constructed, in order to escape the dimension of hopelessness included in the announcement of futility?