When everything is too much. Quantitative approaches to the issue of futility
M. H. Ebell
Department of Family Medicine, Wayne State University, Detroit, Mich., USA.
Although physicians agree broadly that there is no obligation to provide
futile care, there is no consensus, of which I am aware, regarding a
definition of futility. Two quantitative approaches to determining futility
are proposed, neither of which involves financial costs. First, based on
the number of consecutive failures of an intervention, it is possible to
calculate the probability of success for the next attempted treatment. The
second method uses quality-adjusted life years to balance the burden and
benefit of a specific treatment and to determine the probability of success
beneath which the treatment is futile. When applied to the use of
in-hospital cardiopulmonary resuscitation in patients with metastatic
cancer, both of these methods confirm the futility of this intervention.
