The medical futility debate: patient choice, physician obligation, and end-of-life care.

Physicians' use of the "medical futility" concept to override the treatment demands of patients or their family/surrogates is difficult to justify in principle. At the same time, patient demands for obviously futile treatments can conflict with physicians' professional obligation to do no harm to their patients. There is no clear general principle available to resolve this conflict between patient self-determination and physician autonomy; extended negotiation between patient or family/surrogates and physicians provides the only prospect for satisfactory resolution. Though such negotiation will not invariably succeed in reaching agreement, the legal system should ensure that each side has some practical measure of independent authority and power to exert against the other in order to maximize the likelihood that the negotiating process will be seriously engaged.