title: Towards a just, courageous, and honest resolution of the futility debate.
abstract: This essay discusses the history of the "futility debate" and the motives that sometimes prompt health care professionals, health care providers, patients, and surrogates to take different sides in it. Changes in the health care system, financial responsibility shifts, technical medical advances, and medical care rationing are analyzed as contributors to the futility debate. So too are variations in the definition of futility examined as part of the current controversy. The respective attitudes of professionals, providers, patients, and surrogates in accepting the goals, capabilities, and limits of medicine are also explored. In particular, the lack of honest communication between health care professionals/health care providers on the one hand and patients/surrogates on the other is acknowledged as a major roadblock in the building of care-focused futility policies. Finally, various initial attempts of hospitals to create futility guidelines are evaluated in order to detect problem areas and to suggest lines of improvement.
authors.affiliation: Department of Philosophy, Davidson College, North Carolina 28036-1719, USA.
authors.forename: R
authors.initials: R
authors.lastname: Tong
mesh_terms: D000368:Aged; D026686:Beneficence; D032921:Consensus; D003657:Decision Making; D026822:Ethicists; D004992:Ethics, Medical; D005260:Female; D006282:Health Personnel; D006296:Health Services / Q000191:economics; D006801:Humans; D018447:Medical Futility; D028681:Moral Obligations; D010344:Patient Advocacy / Q000331:legislation & jurisprudence; D026684:Personal Autonomy; D024382:Professional Role; D040841:Resource Allocation; D012131:Respiratory Insufficiency; D018570:Risk Assessment; D012945:Social Values; D013315:Stress, Psychological; D028722:Virtues; D028761:Withholding Treatment