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CConfusion surrounds the concept of medical futility.Conflicts persist regarding how to determine what’sreally futile in particular circumstances. The explo-sion of medical technology and the intense mediafocus on real-life cases (promoting public outcryand dissenting views) only serve to foster this per- plexity.1

Definitions of medical futility vary. Consider the following three descriptions: 1. “Futile treatment: Treatment evaluated by the healthcare team, family, or both, as being nonbene- ficial or harmful to a dying patient.”2

2. “Futility means any treatment that, within a rea- sonable degree of medical certainty, is seen to be without benefit to the patient, as when the treatment at issue is seen as ineffective with regard to a clinical problem that it would ordinarily be used to treat.”3

3. “Medical futility refers to interventions that are unlikely to produce any significant benefit to the patient: quantitative futility, where the likelihood that an intervention will benefit the patient is exceedingly poor, and qualitative futility, where the quality of benefit an intervention will produce is exceedingly poor.”4

Clearly, medical futility is a vague concept. Each definition can pose its own challenges and be fraught with dissension upon attempts to move from theory to operational implementation in the clinical arena. Indeed, it may seem futile to attempt to define medical futility.

Agreeing on guidelines Perhaps it’s less important for nurses and health- care organizations to agree upon an absolute defini- tion and more meaningful to determine workable guidelines and a process for addressing medical futility. Having a framework or guideline in place will provide direction and potentially reduce unnec- essary conflicts, which can arise among healthcare providers, patients, families, and community.

A framework would serve as a conduit to open

communication among patients, families, and healthcare providers, and to identify procedural steps to assist them in moving through the process. The literature provides examples of medical futility guidelines to assist organizations developing their own. One example comes from the University of Minnesota Center for Bioethics Model Guidelines for Addressing Medical Futility in End-of-Life Care.2

Six procedural steps, with possible outcomes for the steps, help guide the healthcare team and the patient’s healthcare decision makers from initial identification of medical futility to the discontinua- tion of futile medical treatment (if indicated through the process).

It’s important to note that any framework or guideline should reflect an understanding of social, ethnic, religious, and cultural contributions of the organization and the communities served. Input would be required from diverse sources, including: nurses, physicians, acute care and long-term care representation, social workers, spiritual advisors, community representatives, and legal and ethical consultants.

Communicating conditions Understanding medical futility isn’t limited to the development of a model for medical futility. Equally important is crucial communication, which should occur early on in the patient’s care, between the healthcare team, the patient, and the family. Ideally, all parties are informed and on common ground for the short- and long-term treatment plan, through straightforward efforts in communication, and upon initiation of care.

Proactive, effective, and open communication early on in the treatment plan may circumvent the need for the medical futility process. The question of what’s “futile” often can’t be answered until clear goals of treatment are defined. Disagreements about whether a treatment is futile may often be disagree- ments about the goals of treatment, not futility.5

20 l Nursing2007 Critical Care l Volume 2, Number 1 www.nursing2007criticalcare.com

What is medical futility? By Patricia A. Angelucci, RN, CCRN, CNA, CHE, MS

Nursing Ethics

www.nursing2007criticalcare.com January l Nursing2007 Critical Care l 21

One ethics expert supports this proactive ap- proach by reminding institutions that we haven’t established adequate safeguards along the way, which would enable us to evaluate the reasonable- ness of care rendered and help us desist aggressive care. The article notes, “The team knew beforehand they would be traveling a very rocky road for which intubation served as the first tollgate.”6

The same expert also acknowledges the criticality of communication, but broadens this concept beyond the acute care experience. Provision of futile care may be derived, to some degree, from a long past of ineffective patient and family commu- nications, and perhaps, to some extent, by our cul- ture, our historic hesitation to engage in candid or difficult discussion, and a tendency to want to deny the reality of death.

Valuing communication, understanding treatment goals, and developing guidelines to address medical

futility will move organizations toward a greater understanding of medical futility and improved patient care. v

REFERENCES 1. Angelucci P. Grasping the concept of medical futility. Nurs Man-

age. 2006;37(2):12-14.

2. Barnhart K, Bartels D, Brunnquell D, et al. Model Guidelines for Addressing Medical Futility in End-of-Life Care. Resource Center, University of Minnesota Center for Bioethics; 2004.

3. Wear S, Phillips B, Shimmel S, Banas J. Developing and imple- menting a medical futility policy: one institution’s experience. Community Ethics: Newsletter of the Consortium Ethics Program. Available at: http://www.pitt.edu/~cep/31wear.html. Accessed December 19, 2006.

4. Jecker N. Futility. Ethics in Medicine: University of Washington School of Medicine. Available at: http://eduserv.hscer.washington. edu/bioethics/topics/futil.html. Accessed December 19, 2006.

5. Wilson B. Futility and its uses. Community Ethics: Newsletter of the Consortium Ethics Program. Available at: http://www.pitt.edu/ ~cep/31wils.html. Accessed December 19, 2006.

6. Banja J. How to deliver futile care: some rules. CM Ethics. 1997;July/Aug:28-29.

Patricia A. Angelucci is chief nurse officer and a bioethics committee member at Willamette Valley Medical Center, McMinnville, Ore.