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Part II - Medical futility

Published online by Cambridge University Press:  18 August 2009

Lorry R. Frankel
Affiliation:
M.D. Department of Pediatrics, Division of Gastroenterology, Lucile Packard Children's Hospital, Palo Alto, California 94304, USA
Amnon Goldworth
Affiliation:
Ph.D., Senior Medical Ethicist Lucile Packard Children's Hospital, Palo Alto, California 94304, USA
Mary V. Rorty
Affiliation:
Ph.D. Stanford University Center for Biomedical Ethics, 701 Welch Road, Suite 1105, Palo Alto, California 94304, USA
William A. Silverman
Affiliation:
M.D., Professor of Pediatrics (retired) Columbia University College of Physicians & Surgeons, New York 10032, USA
Lorry R. Frankel
Affiliation:
Stanford University, California
Amnon Goldworth
Affiliation:
Stanford University, California
Mary V. Rorty
Affiliation:
Stanford University, California
William A. Silverman
Affiliation:
Columbia University, New York
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Summary

“Futility” is one of the most controversial issues facing contemporary health care – both in theory and in application. The three cases in this section illustrate the difficulty faced in theory and practice.

The term itself can be confusing. The futility of a particular treatment may be evident in either quantitative or qualitative terms. That is, futility may refer to an improbability or unlikelihood of an event happening, an expression that is quasi-numeric, or to the quality of the event that treatment would produce. In the absence of specific objective criteria consistently applied across different diagnoses and settings, subjective judgments about what is appropriate in a specific case can and do clash. A treatment judged “futile” from one perspective is liable to be termed “desirable” or “necessary” by another participant or affected party: “You may think it is futile, but it does not seem futile to me.” Such conflicting reactions to a situation may reflect different formulations of the goals of treatment. One party may consider an intervention “futile” which only postpones death; another may find an extended time to resolve emotional or family issues priceless. The reliability of factual information cannot settle conflicts arising from these different value positions.

Even in cases where considerable outcomes research has generated probabilistic data about the likelihood of positive results for life-sustaining treatments such as cardiopulmonary resuscitation or mechanical ventilation under some medical conditions, the chance, however minimal, of postponing death can be of great psychological value to grieving parents.

Type
Chapter
Information
Ethical Dilemmas in Pediatrics
Cases and Commentaries
, pp. 85 - 88
Publisher: Cambridge University Press
Print publication year: 2005

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  • Medical futility
    • By Lorry R. Frankel, M.D. Department of Pediatrics, Division of Gastroenterology, Lucile Packard Children's Hospital, Palo Alto, California 94304, USA, Amnon Goldworth, Ph.D., Senior Medical Ethicist Lucile Packard Children's Hospital, Palo Alto, California 94304, USA, Mary V. Rorty, Ph.D. Stanford University Center for Biomedical Ethics, 701 Welch Road, Suite 1105, Palo Alto, California 94304, USA, William A. Silverman, M.D., Professor of Pediatrics (retired) Columbia University College of Physicians & Surgeons, New York 10032, USA
  • Edited by Lorry R. Frankel, Stanford University, California, Amnon Goldworth, Stanford University, California, Mary V. Rorty, Stanford University, California, William A. Silverman, Columbia University, New York
  • Book: Ethical Dilemmas in Pediatrics
  • Online publication: 18 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545504.013
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  • Medical futility
    • By Lorry R. Frankel, M.D. Department of Pediatrics, Division of Gastroenterology, Lucile Packard Children's Hospital, Palo Alto, California 94304, USA, Amnon Goldworth, Ph.D., Senior Medical Ethicist Lucile Packard Children's Hospital, Palo Alto, California 94304, USA, Mary V. Rorty, Ph.D. Stanford University Center for Biomedical Ethics, 701 Welch Road, Suite 1105, Palo Alto, California 94304, USA, William A. Silverman, M.D., Professor of Pediatrics (retired) Columbia University College of Physicians & Surgeons, New York 10032, USA
  • Edited by Lorry R. Frankel, Stanford University, California, Amnon Goldworth, Stanford University, California, Mary V. Rorty, Stanford University, California, William A. Silverman, Columbia University, New York
  • Book: Ethical Dilemmas in Pediatrics
  • Online publication: 18 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545504.013
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Medical futility
    • By Lorry R. Frankel, M.D. Department of Pediatrics, Division of Gastroenterology, Lucile Packard Children's Hospital, Palo Alto, California 94304, USA, Amnon Goldworth, Ph.D., Senior Medical Ethicist Lucile Packard Children's Hospital, Palo Alto, California 94304, USA, Mary V. Rorty, Ph.D. Stanford University Center for Biomedical Ethics, 701 Welch Road, Suite 1105, Palo Alto, California 94304, USA, William A. Silverman, M.D., Professor of Pediatrics (retired) Columbia University College of Physicians & Surgeons, New York 10032, USA
  • Edited by Lorry R. Frankel, Stanford University, California, Amnon Goldworth, Stanford University, California, Mary V. Rorty, Stanford University, California, William A. Silverman, Columbia University, New York
  • Book: Ethical Dilemmas in Pediatrics
  • Online publication: 18 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545504.013
Available formats
×