For patients without a DNR order, the doctor's decision about CPR indications is not being present; in other words, the decision of
medical futility will be sufficient for not performing CPR (2).
(17.)
Medical Futility in End-off-Life Care: report of the Council on Ethical and Judicial Affairs.
In the clinic the
medical futility debate culminates in the practical question of whether physicians may unilaterally discontinue LSMT in the face of opposition from patient/surrogates.
The text also relates that to attempt futile treatment was to display an ignorance "allied to madness." The concept of
medical futility has been counterbalanced by the rapid advance of medical science, especially in the last several decades beginning in the 1960s, when life-sustaining medical treatments such as the mechanical ventilator became available.
"'Always assuming [the treatment] is not medically futile,' Nimer told [Reiff] at some point during [his] mother's last weeks, 'if I can carry out my patient's wishes, I want to do that.'" (17) But the conception of "
medical futility" that Nimer apparently applied was a null set; it had no empirical basis and could not be falsified by any empirical data.
The TADA does not define "medical appropriateness," or "medical inappropriateness," nor does it use the term "
medical futility," the latter arguably being an expression even more ambiguous and vague.
Acceptance of the concept of
medical futility facilitates a paradigm shift from curative to palliative medicine, accommodating a more humane approach and avoiding unnecessary suffering in the course of the dying process.
For the past decade, there has been debate within the medical, ethical, and legal communities focusing on the issue of
medical futility. Despite the emergence of
medical futility as a dominant topic of discussion, especially as it applies to end-of-life care, the concept is not new.
It reflects a body of law on
medical futility that has been evolving throughout the past 3 decades, as the wishes of patients and their surrogates sometimes have been pitted against increasingly sophisticated technology and inflexible hospital policies.
From Thaddeus Mason Pope's blog
Medical Futility, quoting the amended complaint:
A contentious end-of-life issue is that of
medical futility; which basically denotes treatment that cannot confer an overall benefit on the whole person even if it can restore some physiologic variable.
(41) Of note, however, is that two articles addressing physician and nurse attitudes toward
medical futility are from Canada and Japan; both countries with universal health insurance.