Medical futility in end-of-life care - Report of the Council on Ethical and Judicial Affairs

Use of life-sustaining or invasive interventions in patients in a persisten t vegetative state or who are terminally ill may only prolong the dying pro cess. What constitutes futile intervention remains a point of controversy i n the medical literature and in clinical practice. In clinical practice, co ntroversy arises when the patient or proxy and the physician have discrepan t values or goals of care. Since definitions of futile care are value laden , universal consensus on futile care is unlikely to be achieved. Rather, th e American Medical Association Council on Ethical and Judicial Affairs reco mmends a process-based approach to futility determinations. The process inc ludes at least 4 steps aimed at deliberation and resolution including all i nvolved parties, 2 steps aimed at securing alternatives in the case of irre concilable differences, and a final step aimed at closure when all alternat ives have been exhausted. The approach is placed in the context of the circ umstances in which futility claims are made, the difficulties of defining m edical futility, and a discussion of how best to implement a policy on futi lity.