Medical Futility in American Health Care

Abstract

When I began consulting at a major tertiary medical center in September 1989 during a sabbatical year, I had a number of anticipations about what I would find, some explicit and many implicit. One of these anticipations was that in most instances of conflict about forgoing treatment between health care providers and patients or patient surrogates, providers would insist on initiating or continuing aggressive therapy, and patients—or, more often, patients’ families—would ask to have useless or burdensome treatment withheld or discontinued. The medical ethical literature I had read suggested that in cases of conflict, the physicians’ medical approach would be set against the more humane moral sense of patients and families. I anticipated that physicians, and possibly other health care providers, would see disease and death as the main enemies and would try to hold them off at all costs. It would be the families who would ask that their loved ones be allowed to die with dignity, without disproportionate use of medication and technology.