Abstract

The appeal to futility as a justification for physician unilateral decision making has gained popularity in the clinical setting. Though there is a growing body of literature on this use and application of the concept of futility, it has yet to be the subject of a systematic conceptual analysis. ;The purpose of this dissertation is to examine critically the nature and limit of the two classic types of futility appeals made in the clinical setting and to consider whether either formulation is sufficient to justify unilateral decision making. That is, would a physician be justified in refusing unilaterally to offer, provide, or continue treatment based exclusively on her opinion that the treatment in question would be futile? In the standard analysis, the concept of futility is understood to have at least two different meanings, depending upon whether it is more substantially an evaluative or factual judgment. When it is operating as an evaluative judgment, futility is understood to mean that a treatment is inappropriate because it would just not be worth it. When it is operating as a factual judgment, futility is understood to mean that a treatment is ineffective because it would just not work. I argue that neither formulation as currently developed is sufficient to justify physician unilateral decision making. ;My objection to the popular use and formulation of the concept of futility has a number of related dimensions. First, I am critical of the process of decision making advocated by the srongest proponents of the concept of futility: physician unilateral decision making. Second, I am disturbed by the simplistic terms on which clinicians are currently encouraged to make unilateral treatment decisions: futility. Third, I am skeptical of attempts to divide judgments of futility into factual and evaluative statements. Fourth, I find untenable the trend towards privileging judgments of so-called factual or physiologic futility. In light of these objections, I conclude by considering the clinical and public policy implications of my argument