Medical futility.

We examine the concept of medical futility by addressing several questions. Should doctors be attempting treatments that have little likelihood of achieving the goals of medicine? What are the goals of medicine? Can we agree when medical treatment fails to achieve such goals? What should the physician do and not do under such circumstances? Exploring these issues has forced us to revisit the doctor-patient relationship and the relationship of the medical profession to society. Medical futility has both quantitative and qualitative components. We argue that medical futility is the unacceptable likelihood of achieving an effect that the patient has the capacity to appreciate as a benefit. Medicine today has the capacity to achieve a multitude of effects, but none creates a benefit unless the patient has the capacity to appreciate it. In the futility debate wherein some critics have failed or refused to define medical futility, an important area of medicine has been neglected - palliative care - the physician's obligation to alleviate suffering, enhance wellbeing, and support the dignity of the patient at the end of life. To provide a broader perspective we end with a view from Germany.