Applying futility in psychiatry: a concept whose time has come
Abstract
Since its introduction in the 1980s, futility as a concept has held contested meaning and applications throughout medicine. There has been little discussion within the psychiatric literature about the use of futility in the care of individuals experiencing severe and persistent mental illness (SPMI), despite some tacit acceptance that futility may apply in certain cases of psychiatric illness. In this paper, we explore the literature surrounding futility and argue that its connotation within medicine is to describe situations where patients (or their substitute decision-makers) believe that interventions will almost certainly provide no meaningful benefit. We then provide two arguments in support of the use of futility within the care of individuals experiencing SPMI: that some SPMI can be considered a terminal illness, and that the risk-benefit ratio is a dynamic entity such that futility can help describe what Gillett calls the ‘risk of unacceptable badness’ when it comes to considering how an intervention might impact a patient’s quality of life. We posit that capacity should not pose an obstacle to declaring futility when caring for individuals experiencing SPMI and explain how futility is not antithetical to recovery in mental health. Finally, we describe how using futility within psychiatric practice can allow for a reorientation of care by signalling the need to shift to a palliative approach.
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By reliably establishing that suffering is irremediable, we may recognize further curative treatment as futile and shift to palliative approaches.
“By reliably establishing that suffering is irremediable, we may recognize further curative treatment as futile and shift to palliative approaches.”
From Irremediable psychiatric suffering in the context of medical assistance in dying: A delphi-study (2022) · cites this paper as [25]
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- Authors
- Levitt, S., & Buchman, D. Z.
- Affiliations
- University Health Network (CA)
- Corresponding author
- Levitt, Sarah
- Venue
- Journal of Medical Ethics
- Publisher
- BMJ
- Published
- 2020-12-22
- Volume
- 47
- Issue
- 12
- Pages
- e60-e60
- ISSN
- 0306-6800 (ISSN-L)
- 1473-4257
- OpenAlex
- W3117972040
- Cited by
- 40
- References
- 25
- Citations by year
- 2026: 8 · 2025: 2 · 2024: 10 · 2023: 12 · 2022: 5 · 2021: 3
- FWCI
- 3.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Medical Ethics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Keywords
- futility, severe and persistent mental illness, terminal illness, risk-benefit ratio, quality of life, decision-making capacity, palliative care, psychiatric ethics, substitute decision-makers
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