Iranian Journal of Medical Ethics and History of Medicine

Although, physicians have a duty to treat their patients, sometimes the cure is not possible in medicine and there is no result in attempt to cure patient. In this situation, we face with two types of patients: first, patients who are conscious but suffering with advanced disease and will survive only for a short time. The second group, are patients who are unconscious and may not be cured with the standard treatment based on physician experience.
The latter are the subject of the present article. So what a Hospital should do in dealing with these patients? How the hospital, should develop a community-based policy on providing care for these patients. Finally, how should inform the public to adhere to these policies.
 

Medical ethics is an old science. Some of its issues have historical precedence, and others are modern challenges, and have emerged with advances in technology. One of such historic but newly emerging challenges is "bi’natijeghi-e-pezeshki (futile treatment)", which is defined as the treatment that cannot achieve its goal. This term entered medical literature as "medical futility" in late 1980s. Based on this investigation, it can be concluded that this term should only be used when the desired outcome following medical procedure and the outcome sought by the medical team and patient/family (patient's health) is unlikely to be realized. There are various equivalents for this term in our country (Islamic Republic of Iran), including "bi’fayedegi-e-pezeshki (medical uselessness)", "bi’houdeghi (frivolity) in medicine", and even "inappropriate treatment". The present article aimed to find a suitable Persian equivalent for this concept. The use of interpretations such as "frivolity" or "uselessness" may cause misunderstanding between patient/family and the medical team, and can ruin the trust between patient/family and the medical team. Thus, the best alternative to this English term appears to be "bi’natijeghi-e-pezeshki (futile treatment)".

Several definitions for medical futility has been proposed in the literature. Medical futility is defined as the condition in which an intervention, either for diagnosis, prevention, treatment, rehabilitation or other medical goals, has no benefit for the individual patient. This critical review aimed to increase the understanding of physicians and other healthcare providers on the issue of futility in complementary and alternative medicine (CAM). Our comprehensive search resulted in more than 1000 studies; unrelated studies were excluded by title and abstract screening, then 219 full-texts were read and finally, 118 studies were included. The conclusion concerning whether or not it is morally acceptable to provide a futile treatment in CAM, becomes a controversial issue based on different approaches. Using futile treatments is not acceptable according to the duty-based approach, and the principle of justice. In contrast, the case-based approach  and the principle of autonomy of the patient, hold that such treatments could be morally acceptable. Based on utilitarianism, only evidence-based treatments can be morally discussed, and those CAM therapies that have been shown to be futile, should be prohibited; thus health care providers must not offer them to patients since it would be a kind of deceit. We suggest that more comprehensive studies should be performed to clarify the boundary between placebo, nocebo, and futility.