Resolving disputes between clinicians and family about "futility" of treatment

Family resistance to withdrawal of life support from children presents difficult issues of clinical practice and of principle. Legal recognition of unilateral physician authority for withdrawal on grounds of clinical "futility"-even in the most extreme circumstance of brain death-creates inappropriate incentives for clinicians' avoidance of prolonged, emotionally taxing interactions likely to persuade parents to accept the reality of their child's impending or actual death. Although unilateral physician action withdrawing support may sometimes be necessary in response to intractable family resistance, clinicians should nonetheless always understand this course not only as a clinical failure in dealing with families but also as unjustified in principle.