"Futility" is currently being used to categorize both those treatments or procedures which have an unreasonably low percentage chance of achieving the desired goal (quantitative futility) and those whose goals, while achievable, are qualitatively unreasonable (qualitative futility). However, each of these interpretations has problems and the issue of futile care is not as simple or harmless as it might seem.
Quantitative Futility - The treatment or procedure has an unreasonably low percentage chance of achieving the desired goal. This is sometimes called physiological futility. In instances of physiological futility, the health care professional judges that the desired treatment will not restore or improve function. For example, giving antibiotics for a viral cold will neither cure the cold nor improve breathing. In cases like this, the physiologically futile treatment may also be harmful.
Some questions that should be asked with such claims: Who determines what constitutes an unreasonably low chance? Who determines the desired goal?
Qualitative Futility - The goal of the patient or surrogate decision-maker is considered to be unreasonable by the health care professionals treating the patient for at least one of the following reasons:
Some questions that should be asked with such claims: Who determines the harm/benefit ratio and whether it is unreasonable? Are treatments outside of accepted professional practice properly referred to as "futile?" Should rationing decisions be disguised as questions of futility?
Rules of Thumb:
1. Except in mass casualty incidents or situations of severely limited resources (i.e. organ transplantation), the bed-side is not the place to make rationing decisions. It simply is too difficult to make a fair, unbiased decision. Often you do not have sufficient information and you cannot be assured that the resources saved will be used to benefit other patients. Decisions at the policy level have the benefit of time for reflection and communication with many groups. Policies can be applied to all, regardless of the interpersonal dynamics of the individuals involved. They can also be biased, but the risk is less than with individual decisions.
2. Most futility decisions benefit from a second opinion.
3. Always talk with the individuals who are requesting the futile treatment. Communication, emotions, understanding, religious beliefs, etc. often come into play. Remember that the patients loved ones will live with this decision for a long time, even if the patient does not.