CLINICAL ETHICS

Medical futility and physician discretion

M Wreen

Correspondence to:
Correspondence to:
M Wreen
Box 1881, Department of Philosophy, Marquette University, Milwaukee, Wisconsin 53201–1881, USA; Michael Wreen{at}Marquette.edu

Some patients have no chance of surviving if not treated, but very little chance if treated. A number of medical ethicists and physicians have argued that treatment in such cases is medically futile and a matter of physician discretion. This paper critically examines that position.

According to Howard Brody and others, a judgment of medical futility is a purely technical matter, which physicians are uniquely qualified to make. Although Brody later retracted these claims, he held to the view that physicians need not consult the patient or his family to determine their values before deciding not to treat. This is because professional integrity dictates that treatment should not be undertaken. The argument for this claim is that medicine is a profession and a social practice, and thus capable of breaches of professional integrity.

Underlying professional integrity are two moral principles, one concerning harm, the other fraud. According to Brody both point to the fact that when the odds of survival are very low treatment is a violation of professional integrity.

The details of this skeletal argument are exposed and explained, and the full argument is criticised. On a number of counts, it is found wanting. If anything, professional integrity points to the opposite conclusion.

Keywords: aims of medicine; medical fraud; medical futility; physician discretion; professional integrity

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This article has been cited by other articles:

• Gedge, E, Giacomini, M, Cook, D (2007). Withholding and withdrawing life support in critical care settings: ethical issues concerning consent. J. Med. Ethics 33: 215-218 [Abstract] [Full Text]  
• Mohindra, R K (2007). Medical futility: a conceptual model. J. Med. Ethics 33: 71-75 [Abstract] [Full Text]