“Futility” is one of the most controversial issues facing contemporary health care – both in theory and in application. The three cases in this section illustrate the difficulty faced in theory and practice.

The term itself can be confusing. The futility of a particular treatment may be evident in either quantitative or qualitative terms. That is, futility may refer to an improbability or unlikelihood of an event happening, an expression that is quasi-numeric, or to the quality of the event that treatment would produce. In the absence of specific objective criteria consistently applied across different diagnoses and settings, subjective judgments about what is appropriate in a specific case can and do clash. A treatment judged “futile” from one perspective is liable to be termed “desirable” or “necessary” by another participant or affected party: “You may think it is futile, but it does not seem futile to me.” Such conflicting reactions to a situation may reflect different formulations of the goals of treatment. One party may consider an intervention “futile” which only postpones death; another may find an extended time to resolve emotional or family issues priceless. The reliability of factual information cannot settle conflicts arising from these different value positions.

Even in cases where considerable outcomes research has generated probabilistic data about the likelihood of positive results for life-sustaining treatments such as cardiopulmonary resuscitation or mechanical ventilation under some medical conditions, the chance, however minimal, of postponing death can be of great psychological value to grieving parents.