Futility, the Multiorganization Policy Statement, and the Schneiderman Response

This essay offers a brief history of futility, in both sociocultural and medical contexts, with some personal reflection on the disappearance and reappearance of medical futility during the author’s 40-plus years in medicine. It discusses the creation of the Texas Advance Directives Act (TADA), which, even with its flaws, creates the only legal safe harbor for physicians engaged in futility disputes. It also offers reflection on the commendable Multiorganization Policy Statement on “potentially inappropriate treatment” yet comes to the same conclusion as Schneiderman. The words recommended for use in futility disputes are not helpful in facing these disputes. Medical futility appropriately understood transcends pure physiologic, quantitative, or qualitative concepts. Those who seek to help resolve futility disputes must take into account not only these concepts, but also emotional, social, and spiritual factors as well. If we are to collectively face the challenge of medical futility, we must cultivate a more covenantal and communitarian ethical framework, develop processes similar to TADA in other state laws, and teach that the acceptance of finitude does not reduce the sacred value of life.