Medical Futility: Definition & Ethics

Instructor: Artem Cheprasov

Artem has a doctor of veterinary medicine degree.

Should a doctor always treat a patient? You may instinctively reply yes but that's not necessarily true. Find out why as you learn about the concept of medical futility.

A Doctor's Role

In short, what is the role of a doctor? Some of you may say to heal, to treat a patient, to bring someone back to good health, or to save lives. Most would probably agree with that. But did you know that in some cases a doctor may refuse to do one of those things? Namely, treat a patient.

If you think that's wrong, don't rush to judgment just yet. There's a concept that's called medical futility that you need to learn about first.

What Is Medical Futility?

Medical futility refers to a concept where a specific medical intervention is likely to cause far more harm than good and/or not produce any significant benefits for a unique patient during a specific medical situation and at a particular point in time during that specific medical situation. An alternative term for medical futility employed by some is a medically inappropriate treatment.

You need to understand that the key word here is 'benefit' and 'good' rather than 'effect'. For example, a doctor may administer a drug to a patient that will, without a doubt, have some sort of physiological effect on the body. Thus, the medicine is, in some sense of the word, effective. But is it beneficially effective? That's the key point here. If the drug will either do nothing at all or do more harm than good, then administering such a drug or performing such a procedure may be considered medically futile in some cases.

Furthermore, there are two general scopes to the concept of medical futility: quantitative and qualitative. By quantitative, we mean that the chances that the medical procedure or drug will benefit the patient is extraordinarily small. By qualitative, we mean that the beneficial effect the drug or procedure will have is either very small to begin with or outweighed by far greater negative effects.

To illustrate, let's say when medical intervention A works, it is extremely beneficial. But it only works 1 time out of 100,000,000. Quantitatively, it's medically futile; qualitatively, it's not medically futile because when it does work, it's extremely beneficial.

On the flipside, medical intervention B works 100% of the time but its serious negative effects outweigh its beneficial effects by 999 to 1. In other words, medical intervention B is qualitatively medically futile even if not quantitatively so because it always, in some sense, works.

The Ethics Of Medical Futility

If you thought all of that was tricky to begin with, then consider the ethics behind medical futility. Let's paint a case scenario that exposes just a few of the ethical considerations.

Let's say that Robert is a cancer patient. Robert's physician, Dr. Smith, has exhausted all major and standard means of treating his cancer. Robert is desperate because he does not want to die and wants to try everything to extend the quantity and quality of his life. Robert, his family, and Dr. Smith knows there is a drug available that Robert may be a candidate for. Robert and his family push for the use of this drug because they are desperate to preserve his life.

But Dr. Smith is not so sure about this drug. Dr. Smith believes that it is medically futile. His oath states that he should do no harm and is thus under no obligation to offer or give a treatment that would violate this oath. This is so for many reasons:

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