Futility and the care of the perioperative patient

Abstract

Futility in healthcare is an area of significant debate. Generally, a futile treatment is one that is incapable of producing a beneficial result. The degree of benefit required has been contentious in the ethics literature. Different definitions of futility have been proposed to arrive at a consensus regarding which treatments would be provided and to agree on futile interventions that could be withheld. However, each of these definitions has flaws. Some hospitals, healthcare organizations, and states have implemented policies to create a procedural approach to futility disputes. Several authors have advocated discarding the language of futility as it often is an expression of physician frustration and impedes communication between care providers, patients and their surrogates. Many resources are available to assist in difficult cases involving futility including preoperative risk calculators and institutional ethics committees, but, ultimately, the best tool in approaching these challenging situations is open and honest communication between the patient, or surrogate, and the physician.