BEYOND FUTILITY TO AN ETHIC OF CARE

The medical futility debate is usually framed as a conflict between ph ysician and patient (or surrogate) over the right to decide whether a particular life-saving treatment is futile and should not be attempted . Arguments on behalf of physician-determined futility emphasize the l imits of physicians' obligations; arguments on behalf of patient-deter mined futility reflect concerns over the potential erosion of recent g ains in patient autonomy against medical paternalism. Underlying the a rguments of those pressing for ''value-free'' definitions of medical f utility and unlimited obligations of physicians to patients may be fea rs of covert rationing and patient abandonment. Often overlooked in th is debate, both at the bedside and in public commentary, is the ethica l duty of the physician to redirect efforts from life-saving treatment s toward the conscientious pursuit of treatments that maximize comfort and dignity for the patient and the grieving family. To supplement th e limited terms of the futility debate with an ethic of care, physicia ns should lead in advocating greater awareness of the ethics of care i n doctor-nurse interactions, institutional facilities, insurance polic ies, and public education.