Futile treatment - when is enough, enough?

Objective This paper examines two aspects of treatment decision making: withdrawal of treatment decisions made by a patient; and decisions to not proceed with treatment by a health professional. The paper aims to provide an overview of the law relating to the provision of treatment, then highlight the uncertainty as to the meaning of and costs associated with futile treatment.Methods The paper reviews the current legal and medical literature on futile treatment.Results Continuing treatment which is futile is not in the patient's best interests. Futility may be understood in both quantitative and qualitative terms. Recent legal cases have expanded the definition of futility to focus not on the nature of the treatment itself, but also on the health of the patient to whom treatment is provided.Conclusions As Australia's population ages, there is likely to be an increased focus on the allocation of scarce health resources. This will, inevitably, place constraints on the number and variety of treatments offered to patients. The level of constraint will be felt acutely where a proposed treatment offers little clinical efficacy. It is time to try to understand and agree on a workable definition of futility. What is known about the topic? The concept of medical futility and its impact are disputed issues. What does this paper add? The paper places futility in its medico legal context, it offers definitions, costs of futile medical treatment and highlights recent legal developments which re-define futility. What are the implications for practitioners? Practitioners need to be aware of the ongoing impact of definitional disputes relating to futility, the cost of futile treatment and that the nature of futility is changing.