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The DOMINO study group has published the report of its ‘futility study’ of minocycline treatment in HD. Minocycline and a placebo pill were tested over 18 months. A futility study is designed to make it relatively easy for a drug to be recommended for larger studies, but minocycline treatment wasn’t promising enough and the study authors found that further trials with minocycline were “not warr...

End-of-life decision-making is a complex process that can be extremely challenging. We describe a 42-year-old woman in an irreversible coma without an advance directive. The case serves to illustrate the complications that can occur in end-of-life decision-making and challenges in resolving difficult futility disputes. We review the role of advance directives in planning end-of-life care, the r...

The R package gset calculates equivalence and futility boundaries based on the exact bivariate non-central t test statistics. It is the first R package that targets specifically at the group sequential test of equivalence hypotheses. The exact test approach adopted by gset neither assumes the large-sample normality of the test statistics nor ignores the contribution to the overall Type I error ...

This essay surveys the need for a clear and objective definition of medical futility. It is urged that once agreement is obtained for structuring operational guidelines for determining futility, a three-tier decisional structure can be developed for testing whether a given treatment falls within the scope of these guidelines. Under the first tier, the treating physician would be given the prima...

Demands by Patients or their Families for treatment thought to be inappropriate by health care providers constitute an important set of moral problems in clinical practice. A variety of approaches to such cases have been described in the literature, including medical futility, standard of care and negotiation. Medical futility fails because it confounds morally distinct cases: demand for an ine...

The term medical futility is frequently used when discussing complex clinical scenarios and throughout the medical, legal, and ethics literature. However, we propose that health care professionals and others often use this term inaccurately and imprecisely, without fully appreciating the powerful, often visceral, response that the term can evoke. This article introduces and answers 10 common qu...

It probably should not be surprising, in this time of soaring medical costs and proliferating technology, that an intense debate has arisen over the concept of medical futility. Should doctors be doing all the things they are doing? In particular, should they be attempting treatments that have little likelihood of achieving the goals of medicine? What are the goals of medicine? Can we agree whe...