Recent contributions to the literature on the topic of futility have focused primarily on two areas: 1) definitions of the term and 2) the suggestion that cardiopulmonary resuscitation may be futile in certain patients. This suggestion is based on “scientific” measures and analyses of outcomes, describing the low probability of success of CPR in patients over age 70, those with cancer, those with multiorgan failure, etc. The research reported suggests that with such patients the physician need not get the patient's (...) consent to withhold resuscitation; the physician need only inform either the patient or the surrogate that CPR will not be Instituted in the event of an arrest. (shrink)

As noted In Part II of this series, perhaps the most critical elements to define in deciding when treatment Is futile are the goals of therapy from, both the physician's and the patient's point of view. A patient's personal goals are based upon value system., life goals, and personal definition of “quality of life.” These personal goals must then be interpreted and applied in a reasonable and realistic fashion against what the physician has previously described as the legitimate, objective, and (...) attainable therapeutic goals. As far as possible, both, parties must work together to eliminate the uncertainties in their discussion. The ideal situation includes a competent, alert patient and a prudent, caring physician who have had a long-term ongoing relationship. The key to collaboration is communication: a sincere interest in and professional concern for the patient; a willingness to be honest and open; a commitment to talk and to listen; an attempt to make one another feel comfortable in the collaboration; and an effort to recognize and to overcome barriers to communication, whether barriers are personal to either the patient or the physician or are professional, institutional, or societal. (shrink)

The patient was a woman in her 30s who, until the rapid progression of an ultimately fatal neurologic disease, had been a very successful professional, enjoying athletics and an active social life. In the 6 months of swift deterioration, she had gone from being extremely vibrant and energetic to being totally unable to care for her personal needs. There had been no loss of intellectual capacity. Her sister later recounted to Dr. J., the emergency department physician, that she had found (...) the patient unconscious and unresponsive at home and had immediately called the patient's neurologist in a neighboring city. He directed her to call the paramedics. (shrink)

A physician recently asked how to respond in the case of an 87-year-old patient with advanced Alzheimer's disease, who was unable to swallow or tolerate a nasogastric tube, when the family insisted a gastrostomy tube be inserted but the physician believed the intervention futile. That question encompasses some of the crucial issues in the concept of futility of the treatment goals of physician, patient, and family; the rights of patients and families to demand care; physician judgment; family values; and, to (...) the degree that it represents many similar dilemmas, justice. What are professionals saying when they pronounce treatment futile? What are patients' rights if they or their surrogates disagree?The word “futile” implies a precision about outcome probability that we do not have, and it ignores the wide range of treatments for a given diagnosis. Is futile the same as useless or the opposite of hope? Futile for what? Cure? Restora tion of function? Prolongation of life? Relief from pain? Relief from anxiety? Com fort? Reassurance? To satisfy or placate the patient or the family? The word “futile” is so imprecise that, rather than clarifying, it confuses and clutters the discussion. (shrink)