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What does “futility” mean? An empirical study of doctors’ perceptions

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Futile medical treatment is a pressing challenge for Australian clinicians and the Australian health system. Futile treatment can prevent a good death1 and may cause distress to patients and families, as well as moral distress to health professionals.2 Additionally, futile treatment consumes scarce health resources, denying health services to others who could benefit.3

Despite years of debate, the question of how to define futile treatment remains unresolved.4,5 The debate has been linked with the perceived conflict between patient and physician autonomy, with early efforts to reach consensus on a definition of futility seen as an attempt to resolve this conflict.6 However, futile treatment is not always the result of patient or family requests, with studies identifying a range of contributing factors.7,8

Although conceptualised in different ways, futile treatment has been commonly understood in two senses: firstly, the likelihood that treatment will confer patient benefit is unacceptably low (quantitative futility); secondly, the quality of the resulting patient benefit is unacceptably low (qualitative futility).