Knowing when to stop: futility in the intensive care unit

Purpose of the review—Decisions to withdraw or withhold potentially life-sustaining treatment are common in intensive care and precede the majority of deaths. Where families resist or oppose doctors’ suggestions that it is time to stop treatment it is often unclear what should be done. This review will summarize recent literature around futility judgements in intensive care emphasising ethical and practical questions. Recent findings—There has been a shift in the language of futility. Patients’ families often do not believe medical assessments that further treatment would be unsuccessful. Attempts to determine through data collection which patients have a low or zero chance of survival have been largely unsuccessful, and are hampered by varying definitions of futility. A due-process model for adjudicating futility disputes has been developed in Texas, and may provide a better solution to futility disputes than previous futility statutes. Summary—Specific criteria for unilateral withdrawal of treatment have proved hard to define or defend. However, it is ethical for doctors to decline to provide treatment that is medically inappropriate or futile. Understanding the justification for a futility judgement may be relevant to deciding the most appropriate way to resolve futility disputes.