Judgments about whether a particular treatment is futile often arise in the context of resuscitation decisions, but the question can arise about any treatment. For example, consider the following case brought to an ethics committee: An elderly woman with diabetes came to the clinic because she knew they had access to a drug that might make it possible for her to avoid having her foot amputated. The drug was intended to improve wound healing in the presence of potential gangrene. Its use, at the time of the visit, lay somewhere between experimental and standard therapy, and was available only through this one clinic in the county.
Physician A told the patient that the drug would be futile in her case, that amputation was the only possible treatment, and that death was the alternative.
The patient reluctantly consented to the amputation, and it was performed. When the case came to the attention of other doctors at the clinic, questions arose. All the physicians agreed with Physician A that amputation was the better choice for this patient, and that the drug had a very low probability of being effective. However, they were not prepared to agree that a trial would prove absolutely futile because (a) she wanted it and, (b) maybe some good would come of it. Physician A insisted that it would be futile and that, in any case, since the patient was no longer ambulatory, having her foot amputated did not change her condition in any way. Using the drug would certainly not have restored her ability to walk.
The abstract question brought to the committee was, Did Physician A have an ethical obligation to tell the patient that other physicians might assess the possibility of futility differently or, even if they agreed, might still be willing to prescribe the medication that she desired? Despite the abstract clarity of this question, the case is a paradigm of the confused and multi-layered futility question. Physician A's personal judgment about the value of non-ambulatory people keeping all their ambulatory equipment got mixed up with his professional judgment about whether a treatment might offer sufficient 201