Getting Past Words: Futility and the Professional Ethics of Life-Sustaining Treatment

For nearly three decades, clinicians and bioethicists have debated about use of the term futile to describe end-of-life medical interventions that clinicians believe are no longer warranted. In clinical practice, the term is most often invoked when a family of a dying or permanently unconscious patient insists upon such interventions, despite the medical team’s belief or recommendation that they be withheld or withdrawn. This essay argues that each of the commonly used terms for these interventions (futile, inappropriate, and nonbeneficial) captures an important, different, and complementary facet of these conflicts in end-of-life medical care. Rather than continuing to debate which term is best, clinicians and bioethicists should direct their attention to the professional ethics of end-of-life care and the clinical and organizational factors that create or contribute to these so-called “futility cases.”