When to call a course of action futile:
(1) personal or collective experience indicating that the therapy has been useless in the last 100 cases in which it has been used
(2) therapy that merely preserves a person who is permanently unconscious
(3) therapy that cannot end dependence on intensive medical care
(4) therapy that fails to benefit or appreciably improve the person as a whole
If a therapy is determined to be futile, then the authors feel that it is ethical for a physician:
(1) to withhold the therapy without the patient's approval
(2) to discontinue the therapy
Exception: pain relief or comfort care
Factors that may be used to decide whether to make an exception:
(1) terminal condition with short-term survival
(2) minimal cost or burden to others
(3) absence of risk to others
(4) an understandable reason for the request
Limitations:
• The paper was written in 1990 prior to evidence-based medicine (EBM). Adherents of EBM would probably recommend using results of clinical trials rather than the opinion of mere physicians.
