Cited by 1,215Palliative Care and End-of-Life IssuesEthics and bioethics in healthcareEthics and Legal Issues in Pediatric Healthcare

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Medical Futility: Its Meaning and Ethical Implications

Schneiderman, Lawrence J., Jecker, Nancy S., Jonsen, Albert R.·1990·Annals of Internal Medicine

DOI 10.7326/0003-4819-112-12-949

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Abstract

The notion of medical futility has quantitative and qualitative roots that offer a practical approach to its definition and application. Applying these traditions to contemporary medical practice, we propose that when physicians conclude (either through personal experience, experiences shared with colleagues, or consideration of published empiric data) that in the last 100 cases a medical treatment has been useless, they should regard that treatment as futile. If a treatment merely preserves permanent unconsciousness or cannot end dependence on intensive medical care, the treatment should be considered futile. Unlike decision analysis, which defines the expected gain from a treatment by the joint product of probability of success and utility of outcome, our definition of futility treats probability and utility as independent thresholds. Futility should be distinguished from such concepts as theoretical impossibility, such expressions as "uncommon" or "rare," and emotional terms like "hopelessness." In judging futility, physicians must distinguish between an effect, which is limited to some part of the patient's body, and a benefit, which appreciably improves the person as a whole. Treatment that fails to provide the latter, whether or not it achieves the former, is "futile". Although exceptions and cautions should be borne in mind, we submit that physicians can judge a treatment to be futile and are entitled to withhold a procedure on this basis. In these cases, physicians should act in concert with other health care professionals, but need not obtain consent from patients or family members.

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Authors: Schneiderman, L. J., Jecker, N. S., & Jonsen, A. R.
Affiliations: University of California San Diego (US)
Corresponding author: Schneiderman, Lawrence J.
ORCID: Jecker, Nancy S.
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 1990-06-15
Volume: 112
Issue: 12
Pages: 949-954
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/0003-4819-112-12-949
OpenAlex: W2067149985
Cited by: 1,215
References: 28
Citations by year: 2026: 28 · 2025: 29 · 2024: 46 · 2023: 35 · 2022: 38 · 2021: 36 · 2020: 41 · 2019: 55 · 2018: 40 · 2017: 33 · 2016: 39 · 2015: 43 · 2014: 39 · 2013: 44 · 2012: 41
FWCI: 15.39
Type: journal article
Language: en
Open access: closed
Licence: www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations: Annals of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
DigitalGeorgetown (Georgetown University Library) (submittedVersion)
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
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
Keywords: futility, treatment decision-making, withholding treatment, decision analysis, physician judgment, informed consent, end-of-life care
MeSH terms: Critical Care, Ethics, Medical, Euthanasia, Passive, Family, Humans, Patient Participation, Philosophy, Medical, Physician's Role, Probability, Risk Assessment, Patient Selection, Personal Autonomy, Paternalism, Moral Obligations, Withholding Treatment

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Medical Futility: Its Meaning and Ethical Implications

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