Physicians and futile care: using ethics committees to slow the momentum

Given the history of the medical profession's diffident attitude toward patients' rights and its reliance on well-meaning paternalism, the notion that doctors should determine futility and limit access to specific interventions must be carefully scrutinized. Indeed, the emergence of two other themes in health policy and ethics, in particular the living will/power of attorney initative on the one hand and the open discussion of rationing care in Oregon on the other, tends to undermine the key rationales for physician control over futile care. Careful review of all three trends suggests that we ought to brake the momentum in favor of physician determination of futility of care and that ethics committees can be the vehicle to address this goal.