When Does Medical Treatment Become Futile?

More than 5 million Americans require critical care a year because of issues ranging from heart attacks to severe car crashes. But most people don't know the full truth of what happens within the walls of an ICU. Doctors and nurses are often expected to do everything they can, even when it doesn’t necessarily benefit the patient’s overall quality of life. This practice is sometimes called futile care, and an ICU nurse is calling on all of us to think about whether we’d want that kind of care for ourselves and our loved ones.   

What is futile care, and why does it happen? 

Ethicists have started to move away from the term “futility” because “taking care of another person or of oneself is never futile,” says Nancy Berlinger, a senior research scholar at The Hastings Center. She says it would be more accurate to call them “futile interventions — interventions that cannot benefit a person and will create burden and even harm” and are often intended to “interrupt the process of dying.”

One possible example: Using CPR to temporarily revive a patient despite knowing that the rest of their life will be spent in a hospital. Research suggests that a considerable amount of care provided in ICUs could be deemed futile. Why? Well, partly because the health care system incentivizes it. But also because… 

• Patients and families are underprepared. If health care providers aren’t given the proper documents stating a patient’s preferences for treatment or who they want to act as their surrogate decision maker, the standard is often to ‘do everything.’ 

• Providers may be poor communicators. One survey found that nearly 70% of participating ICU workers said their patient received a “slow code,” aka CPR provided less aggressively because the provider may consider the intervention futile but may be unable or unwilling to communicate that to families. 

• There’s a bias towards optimism. People tend to think there’s always something more doctors can do, says Berlinger. Plus, research shows many people believe their loved ones are different and will beat the odds. 

Your Move 

Medical care should only be considered futile if it doesn’t align with the desires of the patient or their loved ones. That’s why it’s important to put these preferences in writing, so you can be more confident that if anything ever happened, you’d be treated according to your values. 

There are two main legal documents to fill out: 

• Advance directive/living will. This is where you can outline your medical preferences, like whether you’d be willing to be put on a ventilator or live in a nursing home.

• Health care proxy/durable power of attorney for health care. This allows you to select someone to act as your decision-maker.  

Make sure the person you've appointed as your proxy also knows where to find these documents and what information is in them. While it may feel uncomfortable or upsetting to discuss, you may find that others have already thought about these things–especially older family members, who have likely experienced more loss. 

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Smart Follow

We feature experts, podcasts, orgs, and other accounts in the health and wellness space worth hitting “follow” on. Our pick this week is: 

Kaelynn Partlow, an autistic advocate and former cast member of Netflix's “Love On The Spectrum”

Credentials: Registered behavior technician and senior therapist at the Project Hope Foundation

Where to follow: @kaelynnvp on Instagram, @kaelynn_vp on TikTok 

Why we follow: Partlow is an educational voice and advocate for the autistic community. She breaks down what terms like “sensory issues” or “executive functioning” actually mean in an accessible way. One highlight? Her actionable tips for navigating life with autism. Like this TikTok about preparing to go to Walmart. Or this one on what it means to “adult” when you’re on the autism spectrum. Her goal: To take autism support from a “luxury” to something everyone — autistic and non-autistic people alike — can access. All while reminding us how cool birds are.