ABSTRACT
Physicians must not offer futile treatment, patients must not request it, and insurers must not pay for it. These desiderata command general assent, but controversy rages about who determines futility and what criteria to use. Commentators assign great importance to the resolution of these issues. For some, including Howard Brody and Laurence Schneiderman, preservation of the integrity of the medical profession requires that physicians determine the futility of treatment relative to goals of medical practice. For others, including James Lindemann Nelson and Robert Veatch, avoiding medical paternalism requires that patients or their surrogates determine futility relative to personal criteria. My thesis is that sound judgments of futility are best constructed in conjoint deliberation of the physician and the patient or surrogate.
