Medical Futility–What Does It Mean?

Futile Care Theory is the proposal that life-sustaining treatment can be withheld or withdrawn, against patients’ or families’ wishes, based on arbitrary “quality of life” and/or “cost-benefit” judgments. In many cases, it is the patient’s life that is deemed futile (i.e., useless)—not the treatment. 

This approach stands in stark contrast to a legitimate medical determination that a specific treatment is ineffective in a patient’s case and therefore is useless.

Patients and their families expect doctors and hospitals to protect and preserve lives, not to decide that some lives are unworthy of care. Nevertheless, hospital “medical futility” policies threaten the lives of unsuspecting patients every day. Such policies, often supported by state laws, result in inexpressible human suffering. 

Consider Texas. In 1999, this state enacted the Texas Advance Directives Act, a section of which is known as “the 10-day law.” When a patient or their surrogates (usually family members) disagree with a physician’s medical futility decision, this law requires that it be reviewed by the hospital’s ethics committee. The committee usually rubber-stamps the decision and then notifies the patient or surrogate that they have up to 10 days to arrange for the patient’s transfer to another facility. After 10 days, according to the law, “The physician and health care facility are not obligated to provide life-sustaining treatment.” [1] Transfer of a critically ill patient, particularly with a medical futility decision in his or her medical record, is often extremely difficult or impossible.

Texas has an inhumane law, but at least it requires notification of patients or surrogates when medical futility decisions are made. In some places, doctors carry out decisions to withhold or withdraw treatment in secret, or without giving hospitalized patients any time to find another healthcare provider or facility.

Hospitals are not the only culprits. Each year, a significant number of patients—typically the most vulnerable patients, the disadvantaged, and African Americans—are denied treatment and/or involuntarily discharged from health clinics that provide their life-preserving care, such as dialysis. Dr. Howard Koh, formerly the assistant secretary for health at the US Department of Health and Human Services, has stated, “Advocacy is the engine for change, and the beauty of it is that it can begin with just one person.” [2] Exactly!

Find out what YOU can do to address the issue of healthcare providers denying patients life-sustaining treatment against their wishes. Call 1-888-221-HALO or email feedback@halovoice.org.

Become a voice for the vulnerable!

[1] Texas Health and Safety Code, Section 166.046.
[2] Robert Allen Bear, MD, “Involuntary Discharge from Dialysis: A Health Care Practice like No Other,” KevinMD.com (blog), MedPage Today, January 9, 2017, 
https://www.kevinmd.com/blog/2017/01/involuntary-discharge-dialysis-health-care-practice-like-no.html.

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