Futility has no utility in resuscitation medicine

Area of Science:

• Medical Ethics
• Emergency Medicine
• Clinical Decision-Making

Background:

• The term "futility" is commonly used in resuscitation efforts but lacks a clear definition and utility.
• Current understanding of "futility" in resuscitation fails to account for the harms associated with these interventions.

Purpose of the Study:

• To critically evaluate the concept and application of "futility" in resuscitation.
• To advocate for a shift towards a benefit-harm balance assessment in resuscitation decisions.

Main Methods:

• Conceptual analysis of the term "futility" in the context of medical resuscitation.
• Discussion of the implications of using "futility" in clinical practice and patient communication.

Main Results:

• The term "futility" is inadequate as it does not consider the harms of resuscitation.
• Achieving a consensus definition of "futility" applicable to all resuscitation scenarios is unlikely.
• The use of "futility" can offend patients and undermine their autonomy.

Conclusions:

• Resuscitationists should abandon the terms "futile" and "futility".
• Clinical decisions in resuscitation should prioritize evaluating the balance of benefits and harms from the patient's perspective.
• A comprehensive assessment of resuscitation utility requires incorporating the harms alongside the benefits.