The Proceedings of the Twenty-First World Congress of Philosophy

Volume 1, 2007

Ethics

Medical Futility and Physician Discretion

Some patients have no chance of surviving if not treated, but very little chance if treated. A number of medical ethicists and physicians have argued that treatment in such cases is medically futile and a matter of physician discretion. This paper is a critical examination of that position. According to Howard Brody and others, a judgment of medical futility is a purely technical matter, and one which physicians are uniquely qualified to make. Although Brody later retracted these claims, he held fast to the view that physicians need not consult the patient or his family to determine their values before deciding not to treat. This is because professional integrity dictates that treatment shouldn't be undertaken. The argument for this claim is that medicine is a profession and a social practice, and thus capable of breaches of professional integrity. Underlying professional integrity are two moral principles, one concerning harm, the other fraud. Both point to the fact that when the odds of survival are very low treatment is a violation of professional integrity. The details of this skeletal argument are exposed and explained, and the full argument is subjected to criticism. On a number of counts, it's found wanting. If anything, professional integrity points to the opposite conclusion.