title: What does "futility" mean? An empirical study of doctors' perceptions.
abstract: OBJECTIVE
  To investigate how doctors define and use the terms "futility" and "futile treatment" in end-of-life care.
  
  
  METHODS
  A qualitative study using semi-structured interviews with 96 doctors from a range of specialties which treat adults at the end of life. Doctors were recruited from three large Brisbane teaching hospitals and were interviewed between May and July 2013.
  
  
  RESULTS
  Doctors' conceptions of futility focused on the quality and prospect of patient benefit. Aspects of benefit included physiological effect, weighing benefits and burdens, and quantity and quality of life. Quality and length of life were linked, but many doctors discussed instances in which benefit was determined by quality of life alone. Most described assessing the prospects of achieving patient benefit as a subjective exercise. Despite a broad conceptual consensus about what futility means, doctors noted variability in how the concept was applied in clinical decision making. More than half the doctors also identified treatment that is futile but nevertheless justified, such as short term treatment that supports the family of a dying person.
  
  
  CONCLUSIONS
  There is an overwhelming preference for a qualitative approach to assessing futility, which inevitably involves variability in clinical decision making. Patient benefit is at the heart of doctors' definitions of futility. Determining patient benefit requires discussing with patients and their families their values and goals as well as the burdens and benefits of further treatment.
authors.affiliation: Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD bp.white@qut.edu.au.
authors.forename: Ben
authors.initials: B
authors.lastname: White
authors.affiliation: Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD.
authors.forename: Lindy
authors.initials: L
authors.lastname: Willmott
authors.affiliation: Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD.
authors.forename: Eliana
authors.initials: E
authors.lastname: Close
authors.affiliation: Queensland University of Technology, Brisbane, QLD.
authors.forename: Nicole
authors.initials: N
authors.lastname: Shepherd
authors.affiliation: University of Queensland, Brisbane, QLD.
authors.forename: Cindy
authors.initials: C
authors.lastname: Gallois
authors.affiliation: University of Queensland, Brisbane, QLD.
authors.forename: Malcolm H
authors.initials: MH
authors.lastname: Parker
authors.affiliation: University of Queensland, Brisbane, QLD.
authors.forename: Sarah
authors.initials: S
authors.lastname: Winch
authors.affiliation: Institute of Health and Biomedical Information, Queensland University of Technology, Brisbane, QLD.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Graves
authors.affiliation: University of Queensland, Brisbane, QLD.
authors.forename: Leonie K
authors.initials: LK
authors.lastname: Callaway
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001315:Australia; D003422:Critical Care / Q000941:ethics*; D003657:Decision Making; D006784:Hospitals, Teaching; D006801:Humans; D018447:Medical Futility / Q000941:ethics*; D010166:Palliative Care / Q000941:ethics*; D010358:Patient Participation; D010817:Physician-Patient Relations / Q000941:ethics*; D011368:Professional-Family Relations / Q000941:ethics; D036301:Qualitative Research