Advance Directives, Due Process, and Medical Futility

Robert L. Fine; Thomas Wm. Mayo

doi:10.7326/0003-4819-140-5-200403020-00024

Letters |2 March 2004

Advance Directives, Due Process, and Medical Futility

Robert L. Fine, MD; Thomas Wm. Mayo, JD

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IN RESPONSE:

Berger suggests that the term futility “defies meaningful or clinically useful definition” and suggests that medically appropriate is the better term. Finucane, on the other hand, acknowledges that futility may have qualitative and/or physiologic components, but he goes on to suggest that futility is a “smokescreen.” Our experience suggests that although some find futility difficult to define, most physicians now know it when they see it (to paraphrase the late Justice Potter Stewart). We find the term useful not as a smokescreen, but as a quick reference to a class of patients who cannot recover or get well, who are either suffering or unable to appreciate the benefit or joy in being alive, and who cannot die easily or peacefully without permission. These are the same patients argued about in the “right-to-die” cases from Quinlan (1976) through Cruzan (1990). The parties seeking to allow death by withholding one or more life-sustaining treatments merely changed from family to medical team.

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2004 American College of Physicians

Letters |2 March 2004

Advance Directives, Due Process, and Medical Futility

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Letters |2 March 2004

Advance Directives, Due Process, and Medical Futility

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