What Does 'Futility' Mean? An Empirical Study of Doctors’ Perception

Medical Journal of Australia, Vol. 204(8), 2016

Posted: 14 Jul 2016 Last revised: 19 Aug 2016

See all articles by Ben White

Ben White

Queensland University of Technology - Faculty of Law

Lindy Willmott

Queensland University of Technology - Faculty of Law

Eliana Close

Queensland University of Technology

Nicole Shepherd

Queensland University of Technology

Cindy Gallois

University of Queensland

Malcolm Parker

University of Queensland - School of Medicine

Sarah Winch

University of Queensland

Nicholas Graves

Queensland University of Technology

Leonie Callaway

University of Queensland

Date Written: 2016

Abstract

Objective(s): To describe how doctors define and use the terms “futility” and “futile treatment” in end-of-life care.

Design, Setting, Participants: A qualitative study using semi-structured interviews with 96 doctors across a range of specialties who treat adults at the end of life. Doctors were recruited from three large Australian teaching hospitals and were interviewed from May to July 2013.

Results: Doctors’ conceptions of futility focused on the quality and chance of patient benefit. Aspects of benefit included physiological effect, weighing benefits and burdens, and quantity and quality of life. Quality and length of life were linked, but many doctors discussed instances when benefit was determined by quality of life alone. Most doctors described the assessment of chance of success in achieving patient benefit as a subjective exercise. Despite a broad conceptual consensus about what futility means, doctors noted variability in how the concept was applied in clinical decision-making. Over half the doctors also identified treatment that is futile but nevertheless justified, such as short-term treatment as part of supporting the family of a dying person.

Conclusions: There is an overwhelming preference for a qualitative approach to assessing futility, which brings with it variation in clinical decision-making. “Patient benefit” is at the heart of doctors’ definitions of futility. Determining patient benefit requires discussions with patients and families about their values and goals as well as the burdens and benefits of further treatment.

Keywords: Futile Treatment, Futility, End of Life Decision-Making, Withholding and Withdrawing Life-Sustaining Treatment, Doctors' Perceptions

Suggested Citation

White, Ben and Willmott, Lindy and Close, Eliana and Shepherd, Nicole and Gallois, Cindy and Parker, Malcolm and Winch, Sarah and Graves, Nicholas and Callaway, Leonie, What Does 'Futility' Mean? An Empirical Study of Doctors’ Perception (2016). Medical Journal of Australia, Vol. 204(8), 2016. Available at SSRN: https://ssrn.com/abstract=2802393

Ben White (Contact Author)

Queensland University of Technology - Faculty of Law ( email )

Level 4, C Block Gardens Point
2 George St
Brisbane, QLD 4000
Australia

HOME PAGE: http://staff.qut.edu.au/staff/whiteb/

Lindy Willmott

Queensland University of Technology - Faculty of Law ( email )

Level 4, C Block Gardens Point
2 George St
Brisbane, QLD 4000
Australia

HOME PAGE: http://staff.qut.edu.au/staff/willmott/

Eliana Close

Queensland University of Technology ( email )

2 George Street
Brisbane, Queensland 4000
Australia

Nicole Shepherd

Queensland University of Technology

2 George Street
Brisbane, Queensland 4000
Australia

Cindy Gallois

University of Queensland ( email )

St Lucia
Brisbane, Queensland 4072
Australia

Malcolm Parker

University of Queensland - School of Medicine ( email )

St Lucia
Queensland 4072
Australia

Sarah Winch

University of Queensland ( email )

St Lucia
Brisbane, Queensland 4072
Australia

Nicholas Graves

Queensland University of Technology

2 George Street
Brisbane, Queensland 4000
Australia

Leonie Callaway

University of Queensland ( email )

St Lucia
Brisbane, Queensland 4072
Australia

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