title: Knowing when to stop: futility in the ICU.
abstract: OBJECTIVE
  Decisions to withdraw or withhold potentially life-sustaining treatment are common in intensive care and precede the majority of deaths. When families resist or oppose doctors' suggestions that it is time to stop treatment, it is often unclear what should be done. This review will summarize recent literature around futility judgements in intensive care emphasising ethical and practical questions.
  
  
  RESULTS
  There has been a shift in the language of futility. Patients' families often do not believe medical assessments that further treatment would be unsuccessful. Attempts to determine through data collection which patients have a low or zero chance of survival have been largely unsuccessful, and are hampered by varying definitions of futility. A due-process model for adjudicating futility disputes has been developed, and may provide a better solution to futility disputes than previous futility statutes.
  
  
  CONCLUSIONS
  Specific criteria for unilateral withdrawal of treatment have proved hard to define or defend. However, it is ethical for doctors to decline to provide treatment that is medically inappropriate or futile. Understanding the justification for a futility judgement may be relevant to deciding the most appropriate way to resolve futility disputes.
authors.affiliation: Institute for Science and Ethics, Department of Philosophy, University of Oxford, Oxford, UK. dominic.wilkinson@adelaide.edu.au
authors.forename: Dominic J C
authors.initials: DJ
authors.lastname: Wilkinson
authors.forename: Julian
authors.initials: J
authors.lastname: Savulescu
mesh_terms: D003422:Critical Care / Q000941:ethics* / Q000592:standards; D005066:Euthanasia, Passive; D006801:Humans; D007362:Intensive Care Units / Q000941:ethics* / Q000592:standards; D018447:Medical Futility / Q000941:ethics*; D016414:Resuscitation Orders; D028761:Withholding Treatment