Response to “Bringing Clarity to the Futility Debate: Don't Use the Wrong Cases” by Howard Brody and “Commentary: Bringing Clarity to the Futility Debate: Are the Cases Wrong?” by L.J. Schneiderman (CQ Vol 7, No 3)

Abstract

In a recent issue of Cambridge Quarterly of Healthcare Ethics, Howard Brody and Lawrence Schneiderman offer contrasting opinions about how to apply the concept of “futility” in medicine. Brody holds that “futility cases” are those in which it is reasonably certain that a given intervention “will not work” when applied for the purpose of attaining a specific clinical goal. To determine which actions are futile, Brody prescribes a division of labor. Patients (or patient surrogates) are charged with choosing the goals of treatment while physicians are charged with determining whether specific treatments will be effective in achieving these goals. Though physicians do not choose specific goals, Brody thinks they have a prerogative to decide whether they can, in good conscience, aid in the achievement of specific patient goals. Let us use “positive validation” to denote choosing between alternative goals and “negative validation” to denote choices about whether one will assist in the pursuit of particular goals. Brody's position is essentially that patients are positive validators and that physicians are negative validators. Brody concludes that treatments that are effective in achieving patients' goals are not futile—even when physicians' personal or professional moral commitments prevent them from offering these treatments for the given purpose. “Futility” applies only where interventions won't “promote a goal that both agree is desirable.”