An Overview on Medical Futility

Medical futility is a concern that often arises when making end-of-life decisions pertaining to starting or stopping life-sustaining interventions and treatments. Futility outside of a medical context is typically defined as the state of uselessness or the impossibility of achieving something. In the context of end-of-life care decisions within a medical setting, medical futility may occur in situations where it’s not possible to achieve further improvement or the treatment itself may now have more burdens than benefits. Sometimes medical futility may also include circumstances where it is unlikely the individual will survive, the quality of life is significantly reduced and is unlikely to improve, treatments are unable to provide any benefit, or death is imminent for the individual receiving the treatment.

Common examples of situations where medical futility might be relevant can include treatments or interventions that are performed for someone that is in a persistent vegetative state or the provision of CPR on someone that is likely going to experience neurological damage and require life support following the resuscitation. Since these are both instances where interventions and treatments are only prolonging life in an instance where the probability is significantly higher that death would be hastened without these interventions, it is medically futile; the chance for survival and recovery is highly unlikely and if it were to happen, the individual would likely experience significantly diminished quality of life.

Medical futility continues to be a topic that is widely controversial and debated among ethicists and health care professionals due to the diverse criteria that can apply in end-of-life scenarios. Since it is not necessarily standardized, it can be challenging for professionals to determine what is medically futile in certain circumstances. Further, what is medically futile for one individual may not be medically futile for another individual due to the circumstances regarding their medical history, their preferences for care, pre-existing conditions, and many other factors.

Another challenge in determining medical futility is being able to align perspectives with the patient’s loved ones. What the provider and care team may perceive as medically futile is not always shared in opinion with the family or substitute decision-maker of the dying individual. It is not uncommon for these individuals to disagree with the decision of the medical staff because they perceive that there may be hope or opportunities for improvement that the medical staff simply does not view as possible from a clinical viewpoint.

Medical futility may sometimes be a concern due to the limited number of resources and equipment available, being mindful that if treatment and resources are being used for someone to which there may be no actual benefit, it may prevent those resources from being used to save the life of someone that would have a higher likelihood of benefit and survival. Additionally, there are many different types of medical futility, and this further contributes to the ongoing discussions of what is and is not medically futile in different scenarios. Some of the most common types of medical futility are included and outlined below for further context.

·      Quality of Life Futility

o   This type of futility is characterized by the perception that although treatment may provide benefit, maintain the individual’s capacity, and not result in imminent death, it will not be able to align with the values and beliefs of the dying individual or those that are aware of their end-of-life wishes.

·      Imminent Demise Futility

o   Although the treatment might provide some benefit to the individual, it is not able to prevent imminent death resulting from the natural progression of the disease or condition.

·      Statistical Futility

o   This type of futility is only relevant in circumstances where intervention or treatment is determined to have less than 1% chance in producing benefit to the individual.

·      Physiologic Futility

o   Characterized by a significantly low change of the intervention or treatment producing the preferred physiologic outcome.

·      Clinical Futility

o   Although the treatment may provide benefit and may not result in an outcome of imminent death, the result of the treatment or intervention will not enable the individual to retain or recover their capacity.

·      Disproportionate Futility

o   Characterized by interventions or treatments that are not able to offer any benefit and may further only contribute burdens or risks to the individual on the receiving end.

·      Non-validated But Plausible Futility

o   Only occurs when the intervention or treatment may be based on theory but does not have any validation or substantial evidence of effect from prior research.