Determination of "futility" in emergency medicine

The practice of emergency medicine routinely requires rapid decisionmaking regarding various interventions and therapies. Such decisions should be bas ed on the expected risks and benefits to the patient, family, and society. At times, certain interventions and therapies may be considered "futile," o r of low expected likelihood of benefit to the patient. Various interpretat ions of the term "futility" and its practical application to the practice o f emergency medicine are explored, as well as background information and po tential application of various legal, ethical, and organizational policies regarding the determination of "futility. Decisions regarding potential benefit of interventions should be based on s cientific evidence, societal consensus, and professional standards, not on individual bias regarding quality of life or other subjective matters. Phys icians are under no ethical obligation to provide treatments they judge to have no realistic likelihood of benefit to the patient. Decisions to withho ld treatment should be made with careful consideration of scientific eviden ce of likelihood of medical benefit, other benefits (including intangible b enefits), potential risks of the proposed intervention, patient preferences , and family wishes. When certain interventions are withheld, special effor ts should be made to maintain effective communication, comfort, support, an d counseling for the patient, family, and friends.