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Review
. 2011 Apr;24(2):160-5.
doi: 10.1097/ACO.0b013e328343c5af.

Knowing when to stop: futility in the ICU

Dominic J C Wilkinson  1 , Julian Savulescu
Affiliations
Review

Knowing when to stop: futility in the ICU

Dominic J C Wilkinson et al. Curr Opin Anaesthesiol. 2011 Apr.

Abstract

Purpose of review: Decisions to withdraw or withhold potentially life-sustaining treatment are common in intensive care and precede the majority of deaths. When families resist or oppose doctors' suggestions that it is time to stop treatment, it is often unclear what should be done. This review will summarize recent literature around futility judgements in intensive care emphasising ethical and practical questions.

Recent findings: There has been a shift in the language of futility. Patients' families often do not believe medical assessments that further treatment would be unsuccessful. Attempts to determine through data collection which patients have a low or zero chance of survival have been largely unsuccessful, and are hampered by varying definitions of futility. A due-process model for adjudicating futility disputes has been developed, and may provide a better solution to futility disputes than previous futility statutes.

Summary: Specific criteria for unilateral withdrawal of treatment have proved hard to define or defend. However, it is ethical for doctors to decline to provide treatment that is medically inappropriate or futile. Understanding the justification for a futility judgement may be relevant to deciding the most appropriate way to resolve futility disputes.

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Figures

Figure 1
Figure 1
Medline citations per year for the Medical Subject Heading “medical futility” from 1990-2009
Figure 2
Figure 2
An approach to determining whether treatment is futile or medically inappropriate, and to resolving futility disputes.
See this image and copyright information in PMC

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