A UK bioethicist named Daniel K. Sokol, who writes nary a word in opposition to Futile Care Theory, aka medical futility (meaning, I suspect, he is a futilitarian), has nonetheless written a valuable informative essay in the British Medical Journal (no link, 13 JUNE 2009 | Volume 338) called “The Slipperiness of Futility.” For example, he defines the different “kinds” of futility:
Although ethically aware clinicians need not be familiar with the vast literature on the concept of futility, they might wish to remember the following four points: • Futility is goal specific. • Physiological futility is when the proposed intervention cannot physiologically achieve the desired effect. It is the most objective type of futility judgment. • Quantitative futility is when the proposed intervention is highly unlikely to achieve the desired effect. • Qualitative futility is when the proposed intervention, if successful, will probably produce such a poor outcome that it is deemed best not to attempt it.
And he points out, physiological futility—which I think a physician should refuse—is the only objective “type.” Indeed, Futile Care Theory isn’t about truly futile interventions, but about withdrawing wanted treatment based on the medical team’s or bioethicists’ values:
As futility is so rhetorically powerful and semantically fuzzy, doctors may find it helpful to distinguish between physiological, quantitative, and qualitative futility. This classification reveals that a call of futility, far from being objective, can be coloured by the values of the person making the call. Like “best interests,” “futility” exudes a confident air of objectivity while concealing value judgments.
Sokol tries to erase the abandoning nature of Futile Care Theory by pulling out the old bromide:
Furthermore, “futile” suggests that nothing can be done. Recall the ancient medical wisdom: “To cure, sometimes. To relieve, often. To comfort, always.” There is always something to be done.
That’s true, as far as it goes, but when you want to live and the bioethicists/physicians don’t think the quality of life is worth the effort or the money, saying that you are still providing “care” rings pretty hollow.
