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Knowing when to stop: futility in the ICU

Wilkinson, Dominic JCa,b,c; Savulescu, Juliana

Current Opinion in Anesthesiology: April 2011 - Volume 24 - Issue 2 - p 160–165
doi: 10.1097/ACO.0b013e328343c5af
Ethics, economics and outcome: Edited by Brian Pollard

Purpose of review Decisions to withdraw or withhold potentially life-sustaining treatment are common in intensive care and precede the majority of deaths. When 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, 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.

aInstitute for Science and Ethics, Department of Philosophy, UK

bThe Ethox Centre, Department of Public Health and Primary Healthcare, University of Oxford, Oxford, UK

cSchool of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia

Correspondence to Dominic J.C. Wilkinson, Oxford Uehiro Centre for Practical Ethics, University of Oxford, Littlegate House, St Ebbes, Oxford, OX1 1PT, UK Tel: +44 1865 286 888; fax: +44 1865 286 886; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.