Futile interventions are usually expensive. Few dispute this. The question is whether limits on futile interventions will lead to significant savings. Some believe that the modest savings from futile intervention policies are not worth the burdens of these policies. Why change our ethics, law, and guidelines for medical decision making when truly futile interventions are so rare?

In this chapter, I argue that the actual cost savings of limiting futile interventions are small, but the potential cost savings are great if we consider futility in a larger context. The futile intervention debate is one of the main arenas in which our society is experiencing a cultural shift. We need to make the transition – painfully and slowly – from the rugged individualism that formed our country to a more communitarian ethic that will help us survive (and perhaps thrive) in the next century.

I consider the cost savings associated with futile interventions at three levels. First, I will review the cost savings of futile interventions that have been documented to date. Second, I consider the cost savings when we expand the futile intervention debate to include inappropriate interventions. Defining inappropriate interventions will require a change in doctors' and patients' attitudes about care near the end of life. These attitude changes could lead to significant cost savings. Third, I argue that a fundamental change in our culture is essential to control health care costs.