Schneiderman et al developed criteria for determining whether a therapy is medically futile or not. The authors are from the University of California San Diego and the University of Washington in Seattle.


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



• 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.


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