1. DETERMINING FUTILE TREATMENTS
SEEKING THE
BEST INTERESTS
OF THE PATIENT

2. DEFINITIONS FUTILITY; MEDICAL FUTILITY
THE INABILITY TO ACCOMPLISH AN INTENDED GOAL
MEDICAL FUTILITY
ANY CLINICAL INTERVENTION WHICH A PHYSICIAN, RELYING ON THE MEDICAL LITERATURE AND HIS/HER CLINICAL JUDGMENT (WEIGHING RELEVANT PROBABILITIES], DETERMINES WILL BE UNABLE TO ACCOMPLISH A PHYSIOLOGICAL GOAL WHICH WILL BENEFIT THE PATIENT.
PERMANENT DEPENDENCE ON INTENSIVE CARE INTERVENTIONS

3. DEFINITIONS PERSONALLY-DETERMINED FUTILITY; CLINICAL FUTILITY
ANY EFFORT TO ACHIEVE A RESULT, WHICH MAY BE POSSIBLE BUT WHICH DOES NOT FALL WITHIN THE PERSONALLY-DETERMINED GOALS OF THE PATIENT (OR SURROGATES WHO CAN LEGITIMATELY SPEAK FOR PATIENTS).
CLINICAL FUTILITY
A JUDGEMENT, WHICH INTEGRATES CONSIDERATIONS OF MEDICAL FUTILITY AND PERSONALLY-DETERMINED FUTILITY INTO A UNIFIED WHOLE AND WHICH REFLECTS THE INTERESTS OF THE TOTAL PATIENT AND THE OTHER INDIVIDUALS WHO ARE LEGITIMATE PARTICIPANTS IN THE DECISIONAL PROCESS.

4. CLINICAL JUDGMENT
THE JUDGMENT MADE BY A HEALTHCARE PROFESSIONAL, WHICH TAKES INTO ACCOUNT THE OBJECTIVE FINDINGS, WHICH SUPPORT A DIAGNOSIS AND PROGNOSIS AND WEIGHS THEM IN LIGHT OF THE PROFESSIONAL’S EXPERTISE AND CLINICAL EXPERIENCE TOGETHER WITH THE PECULIAR CIRCUMSTANCE OF AN INDIVIDUAL PATIENT. SUCH JUDGMENTS ARE MADE WITH DUE REGARD FOR A REASONABLE DEGREE OF MEDICAL CERTAINTY AS DETERMINED IN ACCORDANCE WITH REASONABLE MEDICAL STANDARDS.

5. INADVISABLE TREATMENTS COMPARE WITH FUTILE TREATMENTS
EXTREMELY UNLIKELY TO BE BENEFICIAL
BENEFICIAL EFFECTS BUT EXTREMELY COSTLY
UNCERTAIN OR CONTROVERSIAL BENEFIT
FUTILE TREATMENTS HAVE NO PHYSIOLOGICAL BENEFIT

6. PROCESSING FUTILITY CLEARLY IDENTIFY THE GOAL OF THE INTERVENTION
PHYSIOLOGICAL/METABOLIC
FUNCTIONAL
VALUE
CALCULATE AND INTERPRET PROBABILITIES
CLARIFY VALUES
SET PARAMETERS FOR REASONABLE GOALS
SPECIFIC TIME-LIMITED GOAL
WITNESS A PARTICULAR EVENT
ASSESS BENEFITS REALISTICALLY
DISTINGUISH BETWEEN BENEFIT AND EFFECT
LIMITATIONS ON AUTONOMY
THE SCOPE OF THE RIGHT TO REFUSE TREATMENT IS GREATER THAN THE RIGHT TO CHOOSE/DEMAND TREATMENT
CHOICES ONLY AMONG MEDICALLY INDICATED TREATMENTS
INFORM PATIENTS BUT DO NOT OFFER TREATMENT --- INFORMATION WITHOUT CONSENT