AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. May 2000, Volume 2, Number 5.

Journal Discussion

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Defining Futility?

Readers are referred to an article by SJ Youngner in a 1998 issue of JAMA to discuss whether physicians should continue to use the term futility, which might confuse some patients to think that the appropriate standard of care is not being provided.

Articles and books on bioethics continue to expand in both number and the range of topics discussed. Between 1989 and 1998, more than 4000 articles alone were published in MEDLINE-cited journals. Some of the major topics examined are the patient-physician relationship, end-of-life care, reproductive medicine, genetics, and the allocation of scarce medical resources. From these publications, we will be selecting a handful of articles and chapters, some of which reflect issues of perennial concern to physicians, others reflect more recent quandries resulting from advances in biomedical technology.

A new article or book chapter will be featured every month, accompanied by questions intended to guide readers along the path of ethical reasoning and to promote discussion.

Youngner SJ. Who defines futility? JAMA. 1988;260:2094-2095.

Questions for Discussion

Many patients and their families take "futility" to be synonymous with deliberately failing to provide appropriate care. But just because aggressive treatment is discontinued, or is not elevated, does not mean that appropriate treatment, consistent with the standard of care, is not being given to the patient.

  1. Is there a definition of the term that can move beyond the confusion and help physicians and patients alike to achieve a mutual understanding of treatments that are in patients' best interests?
  2. Or should we simply cease to use "futility"? Explain.
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