What Is “Futile Care” and Why Is Futility an Important Consideration at the End of Life?

According to the University of Minnesota’s Center for Bioethics, medically futile treatments are those that are “highly unlikely to benefit the patient” either by extending survival or enhancing quality of life. However, there is disagreement among bioethicists as to how to define “benefit” in this context and how to proceed when healthcare providers and patients or their surrogate decision makers disagree. 

The issues around medical futility are complex. Ethical considerations include the lack of objective criteria for determining medical futility, which leads to reliance on the judgments of healthcare providers as to whether the care being provided is benefiting the patient or not. Some ethicists have expressed concern that vulnerable populations — the elderly, racial minorities, the disabled and economically and socially disadvantaged — will be denied access to life-saving treatments under the guise of futile care. Others worry that the high cost of life-saving treatments could lead healthcare providers to label some care as “futile” when there is a possibility that some benefit, however small, might be gained. 

Complicating the issue further is the fact that few states in the U.S. have enacted laws that address medical futility. According to the American Bar Association, most states have tackled the issue by creating statutes that allow healthcare providers to refuse to provide treatment on a number of grounds. These include provisions for refusing on the basis of moral, philosophical, religious or personal beliefs, as well as refusing based on the fact that the requested care differs from the accepted standard of care. Fifteen states specifically allow providers to refuse to provide care that they believe will be medically ineffective or inappropriate. Only two states, Maryland and Texas, have outlined procedures for the resolution of disputes about medical futility between patients or their surrogates. Most states simply require that the provider attempt to transfer the patient to another physician or facility who will provide the requested care. 

With that being said, many bioethicists believe that futility can be defined objectively if one considers prognosis, the possibility of recovery and the functional status of the patient. What’s more, by identifying care that is ultimately futile, providers can offer patients and their families more appropriate options, such as hospice, palliative care or a dignified, natural death.  

Sources

University of Minnesota Center for Bioethics. https://health.umn.edu/