Medical futility in end-of-life care: Report of the council on ethical and judicial affairs

Charles W. Plows, Robert M. Tenery, Alan Hartford, Dwight Miller, Leonard Morse, Herbert Rakatansky, Frank A. Riddick, Victoria Ruff, George Wilkins, Michael Ile, Jeffrey Munson, Stephen R. Latham, Linda L. Emanuel*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

275 Scopus citations

Abstract

Use of life-sustaining or invasive interventions in patients in a persistent vegetative state or who are terminally ill may only prolong the dying pro, cess. What constitutes futile intervention remains a point of controversy in the medical literature and in clinical practice. In clinical practice, controversy arises when the patient or proxy and the physician have discrepant values or goals of care. Since definitions of futile care are value laden, universal consensus on futile care is unlikely to be achieved. Rather, the American Medical Association Council on Ethical and Judicial Affairs recommends a process-based approach to futility determinations. The process includes at least 4 steps aimed at deliberation and resolution including all involved parties, 2 steps aimed at securing alternatives in the case of irreconcilable differences, and a final step aimed at closure when all alternatives have been exhausted. The approach is placed in the context of the circumstances in which futility claims are made, the difficulties of defining medical futility, and a discussion of how best to implement a policy on futility.

Original languageEnglish (US)
Pages (from-to)937-941
Number of pages5
JournalJournal of the American Medical Association
Volume281
Issue number10
DOIs
StatePublished - Mar 10 1999

ASJC Scopus subject areas

  • Medicine(all)

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