How Physicians Talk about Futility: Making Words Mean Too Many Things

When applied bioethics confronts the topic of futility, the question of who is to be master turns out to be central: who gets to define the terms of the debate and therefore decide that treatment is “futile” and therefore allowably withheld or withdrawn.

Abstract

“There's glory for you!” “I don't know what you mean by ‘glory,’ ” Alice said. Humpty Dumpty smiled contemptuously. “Of course, you dont—till I tell you. I meant ‘there's a nice knock-down argument.’” “But ‘glory’ doesn't mean a ‘nice knock-down argument,” Alice objected. “When I use a word,” Humpty Dumpty said, in rather a scornful tone, “it means just what I choose it to mean—neither more nor less.” “The question is,” said Alice, “whether you can make words mean so many different things.” “The question is,” said Humpty Dumpty, “which is to be master, that's all.” When applied bioethics confronts the topic of futility, the question of who is to be master turns out to be central. Indeed, much of the literature on futility has focused on exactly this question: who gets to define the terms of the debate? Who gets to decide that treatment is “futile” and therefore allowably withheld or withdrawn?