The true abuse of futility

Futility has wrongly been applied over the past decades to clinical scenarios where treatment disputes exist, but where true physiological futility is not certain. This particularly applies to the pediatric critical care arena, where a major source of ethical debate and moral concern surrounds decisions about appropriateness of treatment, and not necessarily futility. In the pediatric intensive care unit, Schneiderman and colleagues’ (2017) definitions of quantitative and qualitative futility are rarely applicable. Attempted alterations to the definition of futility have failed to encapsulate the complex and complicated clinical scenarios encountered, as well as the difficulty of balancing the provision of best medical advice with parental values and authority. The Multiorganization Policy Statement recognizes the difference between futile and potentially inappropriate treatments and puts forth communication strategies to reconcile disputes about the latter. This approach is of value to the greater medical community, including pediatric critical care, and also restores an important and specific meaning to the term futile—a word whose meaning should be unambiguously clear.