FUTILITY AND THE COMMON COLD - HOW REQUESTS FOR ANTIBIOTICS CAN ILLUMINATE CARE AT THE END OF LIFE

The dominant approach to futility in medicine assumes that the probabi lity and utility of medical interventions may be separated to provide a quantitative (probabilistic) definition of futility. This assumption is not only misleading but also responsible for much of the confusion that futility has engendered in medical discussions. The divorce of u tility from probability is the opposite of how clinicians reason: an i mprobable intervention looks different if it is cheap, easy, and witho ut morbidity than if it is technology intensive, expensive, and likely to involve great pain and suffering. Futility is how physicians descr ibe the sense of being compelled to proceed with resource intensive ca re for marginal benefits. Outside the intensive care unit, physicians weigh and sometimes reject patient requests without the need to invoke futility. By examining the ways that physicians can legitimately eval uate patient requests, we can show that appeals to futility are both u nnecessary and counterproductive. In cases where such appeals are unav oidable, the outpatient model suggests a process to adjudicate the com peting claims of patient autonomy and physician responsibility.