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Debate about the concept of medical futility is often polarized around two views. One is that futility is simply an acknowledgment of the limitations of modern medicine, a corollary of the fact of human mortality. The other is that futility is a judgment that is always grounded in a particular set of values, and that medical professionals have no right to impose their value judgments on patients and families who do not share their perspective. This essay argues that these dichotomous views can be reconciled by appreciating the importance of the context in which the dialogue occurs. When clinicians and families are working collaboratively in a process of shared decision-making, use of the concept of futility in the former sense can be an effective way of capturing the limits of medicine. When communication and trust have broken down and the parties are engaged in a process of conflict resolution, the latter interpretation of futility is necessary in order to demonstrate respect for those who embrace a different set of values and perspectives.