Although exploration of medical futility usually begins with the professional community, the development of treatment abatement guidelines ought to consider the perspective of the public community as well. The professional and public communities must become partners in order to synthesize the two perspectives into a unified approach to the issue of medical futility. This synthesis is an example on the societal level of shared decision making between patient and physician on the clinical level.

This chapter describes specific attempts to develop futility guidelines for local public and professional communities, working separately and together. The projects were the topics of a meeting on the development of treatment abatement guidelines in situations of medical futility held in Kansas City, Missouri, January 26 and 27, 1996. The meeting was facilitated by the Midwest Bioethics Center, with generous funding from Employers Reinsurance Corporation and Hoechst Marion Roussel, Inc. Participants included project directors, national thought leaders, and Midwest Bioethics Center staff. A list of participants can be obtained from the authors.

Such shared decision making is one of the primary goals of the bioethics movement. Adequate attention to the diverse perspectives of differing moral communities when considering issues of respect for autonomy, beneficence, and justice will require careful compromise and search for a middle ground among multiple polarities. Consensus building in a morally pluralistic culture is a challenge to a liberal democratic society.