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19 HEC F. 1 (2007)

handle is hein.journals/hecforum19 and id is 1 raw text is: HEC Forum (2007) 19 (1): 1-12. DOI 10.1007/s10730-007-9032-7 © Springer 2007 Editorial Introduction: Futility in the 21st Century Griffin Trotter The debate about futility in healthcare began long before the term medical futility was in circulation. It is a debate about when medical interventions can or should be withheld or withdrawn on the basis that they do not offer a realistic chance of benefit; it is a debate about what counts as no realistic chance of benefit; and it is a debate about who has the authority to make the final call when such questions are at issue. When Karen Quinlan's family sought to remove her ventilator in the 1970s, it was because they believed it offered no prospects of further benefit for the permanently vegetative Karen. They were opposed in court by a medical establishment that maintained it had a duty to prolong lives-including even the lives of the permanently unconscious.' Healthcare providers in Missouri assumed a similar stance against the family of Nancy Cruzan in 1988. Yet, as Cruzan's doctors testified in Missouri about their sacred pledge to preserve the life of a permanently vegetative patient, doctors further north in Minnesota formulated a radically contrary argument-that medicine's venerable ethical tradition precluded them from offering life-prolonging interventions to permanent vegetative state (PVS) patients (Helga Wanglie in this case) because mere prolongation of life without the prospect of regaining consciousness is not a valid goal of medicine. Stunningly, two high-profile cases occurring at the close of the 1980s had different groups of physicians arguing for precisely the opposite conclusion based on their diverging accounts of professional medical ethics. In both cases, physicians denied the influence of their personal ethical beliefs. Both groups claimed simple loyalty to medicine's objective, timeworn tradition of professional ethics. And both maintained that the matter should be settled by an appeal to professional values, rather than patient or family preferences. The Wanglie case is one of the first in which the term medical futility was explicitly invoked. For over a decade subsequently, it appeared often, usually in contexts similar to Wanglie, where medical professionals sought limits to what they could be required to do against their best medical Griffin Trotter, M.D., Ph.D., Center for Health Care Ethics, Saint Louis University, 221 North Grand Blvd., St. Louis, MO 63103-2006; email: trotterc@SLU.edu.

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