Clinical and Ethical Approaches to Medical Futility in End-of-Life Care: A Scoping Review

Medical futility (MF) remains a complex and debated concept in clinical practice, particularly among patients with terminal illness or limited life expectancy, largely due to inconsistencies in its definition and variability in its application, which complicate clinical decision-making. A scoping review was conducted following the methodologies proposed by Arksey, Levac, the Joanna Briggs Institute, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines to analyze evidence on therapeutic futility in terminally ill adults and the clinical, ethical, and prognostic criteria influencing end-of-life decision-making. A total of 36 published studies were included. Regarding study design, retrospective observational studies predominated (12/36, 33.3%), followed by qualitative studies (9/36, 25.0%), cross-sectional studies (6/36, 16.7%), and, to a lesser extent, prospective or cohort studies (3/36, 8.3%), mixed-methods or case-control studies (2/36, 5.6%), and one case report (1/36, 2.8%). Most studies focused on patients (21/36, 58.3%), primarily in critical care settings or among individuals with advanced disease. A considerable proportion exclusively evaluated healthcare professionals (10/36, 27.8%). Regarding the clinical context, ICUs represented the predominant clinical setting, including general, oncological, surgical, neurological, and medical intensive care units. Other settings included non-critical hospital environments (5/36, 13.9%), oncology-specific settings (3/36, 8.3%), prehospital or emergency care settings (2/36, 5.6%), and additional areas, such as psychiatry, bioethics, or palliative care (3/36, 8.3%). The most frequently identified criterion for MF was the use of treatments without expected clinical benefit (10/36, 27.8%). Ethical and clinical dimensions were addressed across all included studies, with a predominance of multidimensional approaches integrating principles, such as autonomy, beneficence, and justice. Small sample sizes and single-center designs predominated, particularly among qualitative and retrospective studies. MF is a complex and multidimensional concept influenced by clinical, ethical, and sociocultural factors. The heterogeneity in its definition and application complicates the standardization of decision-making, particularly in settings such as ICUs.