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Futility and utility

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The physician should focus on what can be done, not on what cannot

“Futility” is a term that has come into prominence in the medical literature over the past two to three decades. This rise has been led primarily by medical ethicists, and has particularly focused on its place in end-of-life discussion.1 Futility is addressed in this issue of the MJA by White and colleagues,2 who examined its use in a Brisbane hospital by undertaking a survey and interviews with 96 public hospital specialists and trainees from 16 specialties. They found that the term was widely employed, but also that there was some confusion about its meaning and when to invoke it. It is commonly involved in end-of-life care, when medical treatments and interventions no longer seem likely to benefit the patient, either by achieving longer survival or by enhancing their comfort and dignity. A few respondents were confident that available evidence can guide objective decision making in end-of-life situations, but most felt that the uncertainty that attends a patient’s terminal days encourages indecision about whether to regard a particular treatment as futile.

Futility is an absolute term; an intervention is either futile or it is not. If it is declared futile, a treatment should be suspended. This finality of the decision that a treatment is futile can disturb both doctor and…