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The futility of Futility: death causation is the 'elephant in the room' in discussions about limitation of medical treatment


Ashby, MA, The futility of Futility: death causation is the 'elephant in the room' in discussions about limitation of medical treatment, Journal of Bioethical Enquiry, 8, (2) pp. 151-154. ISSN 1176-7529 (2011) [Refereed Article]

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Copyright 2011 Springer Science+Business Media B.V.

DOI: doi:10.1007/s11673-011-9291-5


The term "futility" has been widely used in medical ethics and clinical medicine for more than twenty years now. At first glance it appears to offer a clear-cut categorical characterisation of medical treatments at the end of life, and an apparently objective way of making decisions that are seen to be emotionally painful for those close to the patient, and ethically, and also potentially legally hazardous for clinicians. It also appears to deal with causation, because omission of a futile treatment cannot surely be a cause of death. The problem is that futility can be argued to be a "false friend", in that it gives an appearance of representing a reliable conceptual basis, in ethics, for limitation of medical treatment—usually in the context of dying—without actually doing so. In fact, the concept of futility is a conflation of clinical judgement about outcomes of treatment and the quality or even value of life, and has really failed to contribute much to the advancement of decision-making and hence care at the end-of-life. It also has the capacity to medicalise the personal space. Deliberations about the likely outcomes of medical treatment are necessary, and medical expertise is pivotal. However, futility is argued to have a better future in partnership with a broad social action agenda about the process of dying, such as that articulated in health promoting palliative care, as a basis for better "death-ways" in the 21st century (Kellehear 2005). Medicine needs to more honest and upfront about its limits, as death is, after all, the elephant in everybody's room.

Item Details

Item Type:Refereed Article
Keywords:futility, end of life, palliative care, death, medical decision-making
Research Division:Health Sciences
Research Group:Epidemiology
Research Field:Epidemiology not elsewhere classified
Objective Division:Health
Objective Group:Public health (excl. specific population health)
Objective Field:Preventive medicine
UTAS Author:Ashby, MA (Professor Michael Ashby)
ID Code:77840
Year Published:2011
Web of Science® Times Cited:9
Deposited By:Medicine
Deposited On:2012-06-01
Last Modified:2015-01-22

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