Futility

Despite wide recognition that it cannot be meaningfully and univocally defined, the term “futility” is sometimes invoked in medical cases where there is reason to doubt (1) the medical efficacy of the treatment (“it won't work”), or (2) whether it will improve quality of life (“it's not worth it”). Its ordinary-language connotations make it very difficult to convert the term into a technical term with a specific and limited meaning, but since its first introduction in 1987 in connection with CPR it has been used with increasing frequency as a shorthand for a variety of scientific and subjective reasons for not offering, or for suggesting withdrawal of, medical therapies.

The court cases related to futility are of two kinds. In the first kind, if the family or surrogates wish to withhold or withdraw life-sustaining treatments, they may do so (with evidence of patient preferences, as in the Quinlan case of 1976), including withdrawal of medical nutrition and hydration (if the state allows it, as in the Cruzan case of 1990). In the other kind of case, surrogates wish to institute or continue care that the team or facility considers ineffective or inadvisable. If the team are unable to reconcile themselves to offering life-sustaining treatment, they must transfer the patient to an alternative physician or facility which will provide the care (as happened with Baby Ryan Nguyen in 1994) or, if that facility is not equipped for emergency care, must continue to provide the care themselves (as occurred in the Baby K case).