The Abuse of Futility

Two recent policy statements by major providers of critical care have rejected the concept and language of “medical futility,” on the ground that there is no universal consensus on a definition. They recommend using “potentially inappropriate” or “inappropriate” instead. We argue that their proposed terms are vague—even misleading—in the ICU setting, where serious life-and-death decisions are made. Whatever specific meaning the exclusive world of critical care might wish to give to the word inappropriate, in the lay world the term is so broad it trivializes the activity. We also point out that there is no universal consensus on the definition of death, the right to abortion, or the right to refuse blood products, yet medicine carries on. One advantage of the term “medical futility” is that it confirms unambiguously that human beings are mortal, and medicine’s powers are limited. It leads more naturally to integrating palliative and comfort care into critical care decision-making and encourages health providers to think more deeply about their role in the inevitable ending of their patients’ lives.