title: A preventive ethics approach to counseling patients about clinical futility in the primary care setting.
abstract: Given the current themes of futility and managed care in medicine and bioethics, the primary care setting needs to account for how to address futility. We argue for applying the concept of clinical futility to primary care medicine. A preventive ethics approach directs the primary care physician to explain and counsel against futile interventions, with a negotiation strategy for circumstances of disagreement. These efforts will require primary care physicians to concentrate their efforts on education, negotiation, and enhanced trust in their patient relationships. Using a preventive ethics approach in these circumstances, the physician can better protect the interests of the patient by avoiding nonbeneficial interventions, especially those that also are potentially harmful.
authors.affiliation: Department of Family Practice, University of Michigan, Ann Arbor, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Doukas
authors.forename: L B
authors.initials: LB
authors.lastname: McCullough
mesh_terms: D032722:Advance Care Planning; D030881:Disclosure; D028741:Ethics Committees, Clinical; D004992:Ethics, Medical; D005194:Family Practice; D006801:Humans; D018447:Medical Futility; D010353:Patient Education as Topic; D010819:Physician's Role; D011320:Primary Health Care; D014481:United States; D028761:Withholding Treatment