Odds and Ends: Trust and the Debate over Medical Futility

Much of what passes for methodology in bioethics goes by the name of conceptual analysis. Or, to put it another way, bioethicists spend much of their time arguing about the precise meanings of words. Persons who do not have the temperament or the patience for such verbal dissection use less flattering, albeit more colorful, descriptions, in which images of heads located in clouds or dances done on the head of a pin (or worse) loom large. The ongoing wrangling about the concept of medical futility [1] is a perfect example of why some find bioethics valuable and others do not.

On the plus side, careful analysis of the concept of medical futility has produced several crucial insights that have immediate practical application. Medical futility must be understood as referring to both the probability and the desirability of attaining a particular diagnostic, therapeutic, or palliative goal [2-4]. Practitioners must be alert to both dimensions in dealing with patients, colleagues, students, and families.

On the minus side, analysis of the concept has failed to produce a consensus about how it should be defined or used. Many analysts who have gone to the plate and taken mighty swings at defining futility find themselves disagreeing about the soundness of probability estimates of success expected now or in the future from particular treatments [5-7], about which persons should be involved in estimating the chance for success [4, 8], about the value that should be assigned to attaining particular goals for …