A Critical Analysis of Futility Discourse in Pediatric Critical Care

The primary purpose of this article is to critically examine the state of the medical ethics literature and discourse around the concept of futility in pediatric intensive or critical care. The secondary purpose is to identify the conceptualization of futility by different authors, the tensions that exist in the discourse around futility, and the variables that exist in cases when futility is thought to occur. Identification of concepts, tensions, and variables will help to identify the social structure around issues of futility in pediatric intensive care. Seventeen articles were included for summative content analysis. Four conceptions of futility were found: unclear, against medical standards, a subjective value judgment, and not a unilateral conception. The major tensions that emerged, in order, were that futility is based in relationships and responsibility, is goal oriented, and based in beliefs and values. The most reported variable was conflict between parents and careproviders, followed by mechanical ventilation, neurologic devastation, terminal illness, uncertainty, and aggressive treatment. Given that the main variable found was conflict, the main tension was relational, and no consensus on futility was found, it appears that unless there is investigation into the mechanisms of conflict and relational tensions around futility, this phenomenon will continue to appear in the medical ethics literature.