This paper introduces the medical factual matrix as a new and potentially valuable tool in medical ethical analysis. Using this tool it demonstrates the idea that a defined medical intervention can only be meaningfully declared futile in relation to a defined goal(s) of treatment. It argues that a declaration of futility made solely in relation to a defined medical intervention is inchoate. It recasts the definition of goal futility as an intervention that cannot alter the probability of the existence of the important outcome states that might flow from a defined intervention. The idea of value futility and the extent of physician obligations in futile situations are also addressed. It also examines the source of substantive conflicts which commonly arise within the doctor-patient relationship and the ensuing power relations that operate between doctor and patient when questions of futility arise.
- DNAR, do not attempt resuscitation
- MFM, medical factual matrix
- NHS, National Health Service
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↵i Here, medical intervention means a possible action that may affect the physical or mental state of the patient, which is under consideration by medically qualified people responsible for the care of the patient.
↵ii This view has analogies in quantum mechanics—for example, Schrödinger’s cat.
↵iii Net benefit = (probability of benefit×amount of benefit)−(probability of harm×amount of harm)−cost of intervention. Each valuer will view this equation from his or her own particular perspective.
↵v The House of Lords in Bland (footnote iii) seems to have applied the Bolam test here (Bolam v Friern Hospital Management Committee  2 All ER 118), essentially importing medical professional values (effectively both general professional values and the personal professional values of the clinical team responsible).
↵iv This situation may arise, for example, if the net benefit calculation is affected by the cost of treatment, there are multiple valuations of the MFM in operation or the uncertainty surrounding the accuracy of the linking probabilities is large.
↵vi Note facts cf In re Storar (1981) 420 US 858, where blood transfusions were given for anaemia secondary to bladder cancer.
Competing interests: None.
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