Numerous definitions of futility have been proposed, but none have been universally accepted. The concept of futility is sometimes used to describe any effort to achieve a result that is possible but which experience suggests is highly improbable and cannot systematically be reproduced. [Source: Schneiderman, LJ, Jecker, NS, and Jonsen, AR, "Medical Futility: Its Meaning and Ethical Implications," Annals of Internal Medicine 112 (1990): 949-54.] This definition offers both precision and flexibility to account for circumstances, but leaves open the question of what constitutes "highly improbable."
The concept of futility also has been described as any effort to achieve a result that is unreasonable or impossible. This definition is intended to cover treatments that: 1) will not serve any useful purpose; 2) cause needless pain and suffering; and 3) do not achieve the goal of restoring the patient to an acceptable quality of life. [Source: Nelson, LJ and Nelson, RM, "Ethics and the Provision of Futile, Harmful, or Burdensome Treatment to Children," Critical Care Medicine 20 (1992): 427-433.] This definition may be criticized for being too broad, encompassing judgments about disproportionate or extraordinary means. Traditionally, the principle of disproportionate or extraordinary means includes futility as a criterion, but is a broader principle that includes a burden/benefit analysis. Furthermore, the principle of disproportionate or extraordinary means indicates whether or not one is morally obliged to accept a treatment, whereas a judgment of futility typically concerns whether or not a treatment should be offered in the first place.
"The right of the patient to choose does not imply the right to demand care beyond appropriate options based on medical judgment and accepted standards of care . . ." [Source: AMA Council on Ethical and Judicial Affairs, "Ethical Considerations in Resuscitation," JAMA 268 (1992): 2282-88.] In other words, there is no professional or moral obligation to offer or provide a treatment that is determined to be futile according to the standard of care. Technically, this is not a definition, but a consideration of the ethical implications of treatments being characterized as futile. The statement illustrates one appropriate limit of patient autonomy.
The concept of medical futility always contains three formal elements: 1) a desired goal; 2) an action aimed at attaining that goal; and 3) virtual certainty that the action will fail to attain that goal. Most disputes regarding medical futility, then, concern either what should count as virtual certainty or what goals are appropriate to a specific treatment. [Source: Trotter, G, "Mediating Disputes About Medical Futility," Cambridge Quarterly of Healthcare Ethics 8 (1999): 527-37.] This analysis recognizes that there are value-laden judgments involved in determinations of futility, inasmuch as any judgment concerning the worthiness of a goal or end is a value judgment or moral judgment. Exactly who should determine the worthiness of the goal of a specific medical intervention is the subject of much debate. [See: Brody, H, "Bringing Clarity to the Futility Debate: Don’t Use the Wrong Cases," Cambridge Quarterly of Healthcare Ethics 7 (1998): 269-272. Schneidermann, LJ, "Bringing Clarity to the Futility Debate: Are the Cases Wrong?" Cambridge Quarterly of Healthcare Ethics 7 (1998): 273-278.]
