Futile, non-beneficial, potentially inappropriate or ‘disputed’ treatment

This chapter examines the concept of futility in end-of-life decision-making. The term is generally used to describe the situation where the clinical treating team consider potentially life-sustaining treatment should not be provided. But the term ‘futility’ is a vexed one. Alternative terminology has been proposed such as ‘non-beneficial’ or ‘potentially inappropriate’ treatment. We contribute to these debates by offering another term – ‘disputed treatment’ – albeit one more limited in its application to where there is a disagreement about treatment. The chapter then traces key debates in the literature including attempts to define the term futility conceptually, and later empirically. A more recent body of work has also proposed a procedural approach to resolving futility disputes. Unsurprisingly, given the subjectivity of this concept, all of these approaches have been critiqued and these objections are considered. The chapter also considers the value of a concept like futility and its relationship with the distinct issue of health rationing. A final contribution is to offer an alternative approach to disputes about treatment that challenges the idea that futility decisions are ones for doctors, but also constrains the power of patients and substitute decision-makers to demand treatment