Medical futility in pediatrics: is it time for a public policy?

For the past decade, there has been a debate raging within the medical, ethical, and legal communities focusing on the issue of medical futility. What has fueled the fires of this multi-faceted debate is the patient rights movement and the perception that the right to self-determination extends not only to the refusal of medical treatments but to demands for overtreatment. The medical specialities of Pediatrics and Neonatology further complicate this issue because despite the dramatic technological advances in these areas, diagnostic and prognostic certainty for many medical conditions remains illusive. As a result, surrogates have to decide whether children with various congenital anomalies, diseases, and genetic defects should be treated aggressively if at all. This uncertainty has led to conflicts between physicians and families about whether certain medical treatments are futile and thus not in the best interest of the child. From a legal and ethical perspective, one way to resolve these conflicts would be a specific process-based public policy approach to futility determinations on a case-by-case basis. The medical futility policy proposed as a public policy protects the patient's right to self-determination; the physician's right of professional integrity; society's concern for the just allocation of scarce medical resources; and is securely rooted in the ethical tradition of promoting and defending human dignity.