Analiza i Egzystencja

ISSN: 1734-9923     eISSN: 2300-7621    OAI    DOI: 10.18276/aie.2021.53-03

Issue archive / 53 (2021)
Medical Futility or Persistent Therapy? A Dispute over the Terms and Definitions in the Polish Context

Authors: Marcin Ferdynus ORCID
Katolicki Uniwersytet Lubelski Jana Pawła II
Keywords: persistent therapy medical futility extraordinary medical procedures terminally ill patient
Year of publication:2021
Page range:25 (43-67)
Cited-by (Crossref) ?:


This article presents the current discussion around the terms “medical futility” and “persistent therapy” and their definitions. This discussion is based on the dis-pute of whether the term “persistent therapy” should be rejected and replaced with the term “medical futility” in Polish bioethical and medical regulations.The dispute started after the Polish Working Group on End-of-Life Ethics (PWG) had published its definition of persistent therapy in 2008. To settle the dispute, the author proposes amodified version of the PWG’s definition of persistent therapy that combines persis-tence and futility. He argues that persistent therapy is the application of extraordinary or causally inefficacious medical procedures to sustain the life of aterminally ill patient. He also asserts that medical futility can be useful for bioethics only when its definition is limited to medical factors.
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1.Aghabarary, M., Nayeri, N.D. (2016). Medical futility and its challenges: a review study. Journal of Medical Ethics and History of Medicine. Retrieved from:
2.Andersen, P.M., Abrahams, S., Borasio, G.D., Carvalho de, M., Chio, A., Damme Van P., Weber, M. (2012). EFNS guidelines on the clinical management of amyotrophic lateral sclerosis (MALS) – revised report of an EFNS task force. European Journal of Neurology, 19, 360-375.
3.Aszyk, P. (2006). Granice leczenia. Etyczny problem odstąpienia od interwencji medycznych. Warszawa: Rhetos.
4.Bazaliński, D., Marciniec, I., Sałacińska, I., Przybek-Mita, J., Więch, P. (2018). Doświadczenie uporczywej terapii w pracy pielęgniarek pracujących w oddziałach intensywnej terapii - doniesienie wstępne, Anestezjologia i Ratownictwo, 12, 52-61.
5.Beauchamp, T.L., Childress, J.F. (2012). Principles of Biomedical Ethics. 7th ed. New York, Oxford: Oxford University Press.
6.Bołoz, W., Krajnik, M. (2008). Definicja uporczywej terapii. Konsensus Polskiej Grupy Roboczej ds. Problemów Etycznych Końca Życia. Medycyna Paliatywna w Praktyce 2 (3), 77-77.
7.Bosslet, T.G., Pope, M.P., Rubenfeld D.G., Lo, B., Truog D.R., Rushton, H.C., White, B.D. (2015). An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units. American Journal of Respiratory and Critical Care Medicine, 191,1318-1330.
8.Brody, B.A., Halevy, A. (1995). Is futility a futile concept? Journal of Medicine and Philosophy, 20,123-44.
9.Brody, H. (1997). Medical futility: a useful concept? In: Zucker M.B., Zucker H.D. (eds.) Medical futility and the evaluation of life-sustaining interventions. Cambridge: Cambridge University Press, 1-14.
10.Budziński, R. (2016). Uporczywa terapia we współczesnej medycynie. Gdańsk: Bernardinum.
11.Burkle, C.M., Benson, J.J. (2012). End-of-Life Care Decisions: Importance of Reviewing Systems and Limitations After 2 Recent North American Cases. Mayo Clinic Proceedings, 87, 1098-1105.
12.Burt, R.A. (2002). The Medical Futility Debate: Patient Choice, Physician Obligation, and End-of-Life Care. Journal of Palliative Medicine, 5, 249-254.
13.Caplan, A.L. (2012). Little Hope for Medical Futility. Mayo Clinic Proceedings, 87,1040-1041.
14.Cassell, E.J. (2016). The Nature of Suffering. In: Youngner, A.J., Arnold, R.M. (eds.) The Oxford Handbook of Ethics at the End of Life. New York: Oxford University Press, 216-226.
15.Catechism of the Catholic Church. Retrieved from: (07.01.2021).
16.Chyrowicz, B. (2015). Bioetyka. Anatomia sporu. Kraków: Znak.
17.Courtwright, A. (2012). Who Is ‘Too Sick to Benefit’? Hastings Center Report, 42, 41-47.
18.Curtis, J.R., Park D.R., Krone, M.R., Pearlman, R.A. (1995). The Use of the Medical Futility Rationale in Do Not Attempt Resuscitation Orders. Journal of the American Medical Association, 273, 124–128.
19.Ferdynus, M. (2017). Przedłużanie życia jako problem moralny. Tarnów: Biblos.
20.Ferdynus, M. (2018). Rezygnacja z uporczywej terapii. Problem odmowy podłączenia do respiratora w przypadku pacjentów chorych na stwardnienie zanikowe boczne. Perspektywa "Evangelium vitae". Ethos, 122, 409-422.
21.Groarke, L. (2019). Consistent Liberalism does not Require Active Euthanasia, The Heythrop Journal, 60, 895–909.
22.Heland, M. (2006). Fruitful or futile: intensive care nurses' experiences and perceptions of medical futility. Australian Critical Care, 19, 25–31.
23.Hoehn, S.K. (2019). Conflict between Autonomy and Beneficence in Adolescent End-of-Life Decision Making, The National Catholic Bioethics Quarterly, 19, 55–60.
24.Hughes, R.C. (2020). Egalitarian Provision of Necessary Medical Treatment. The Journal of Ethics, 24, 55-78.
25.Jenal, L.B., Moreno, J. (2017). Not the Worst Thing. Life and Death in Clinical Ethics. Createspace Independent Publishing Platform, Wood Dale.
26.Jox, R.J., Schaider, A., Marckmann, A.G., Borasio G.D. (2012). Medical futility at the end of life: the perspectives of intensive care and palliative care clinicians. Journal of Medical Ethics, 38, 540-545.
27.Kant, I. (2012). Groundwork of the metaphysics of morals (1785), tr. Gregor and Timmermann. Cambridge: Cambridge University Press.
28.Kearns, A., Gordijn, B. (2018). Withholding and Withdrawing Life–Saving Treatment: Ordinary/Extraordinary Means, Autonomy&Futility. Analiza i Egzystencja, 42, 5–33.
29.Kerstein, S. (2019). Hastening death and respect for dignity: Kantianism at the end of life. Bioethics, 33, 591–600.
30.Kopelman, L.M. (1995). Conceptual and Moral Disputes About Futile and Useful Treatments. The Journal of Medicine and Philosophy, 20,109-121.
31.Krajewski, R. (2008). Komentarz do definicji. Medycyna Paliatywna w Praktyce, 2(3), 78-78.
32.Kübler, A., Siewiera, J., Durek, G., Kusza, K., Piechota, M., Szkulmowski, Z. (2014). Guidelines regarding the ineffective maintenance of organ functions (futile therapy) in ICU patients incapable of giving informed statements of will. Anaesthesiology Intensive Therapy, 46, 229–234.
33.Kübler, A. (2016). Terapia daremna na oddziale intensywnej terapii. Retrieved from: (15.01.2021).
34.Lantos, J. (2006). When Parents Request Seemingly Futile Treatment for Their Children. Mount Sinai Journal of Medicine, 73, 587-589.
35.Lombard, J. (2018). Law, Palliative Care and Dying. Legal and Ethical Challenges. London, New York: Routledge.
36.Macauley, R.C. (2018). Ethics in Palliative Care. A Complete Guide, New York: Oxford University Press.
37.McAndrew, N.S., Hardin, J.B. (2020). Giving nurses a voice during ethical conflict in the Intensive Care Unit. Nursing Ethics, 27(8), 1631–1644.
38.Nates, J.L., Nunnally, M., Kleinpell, R., Blosser, S., Goldner, J., Birriel, B., Sprung, C.L. (2016). ICU Admission, Discharge, and Triage Guidelines: A Frame-work to Enhance Clinical Operations, Development of Institutional Policies, and Further Research. Critical Care Medicine, 44, 1553–1602.
39.Napier, S. (2020). Uncertain Bioethics. Moral Risk and Human Dignity. New York: Routledge.
40.Orłowski, T. (2009). Zasada proporcjonalności a problem uporczywej terapii. Retrieved from: (27.01.2021).
41.Paris, J.J., Cummings, B.M., Moore, P.M. (2019). Compassion and mercy are not helpful in resolving intractable family-physician conflicts on end-of-life care, Journal of Perinatology, 39, 11–17.
42.Pellegrino, E.D. (2000). Decision at the End of Life: The Use and Abuse of the Concept of Futility. Retrieved form: (24.01.2021).
43.Pellegrino, E. (2015). Decisions at the end of life – an abuse of the concept of futility. Practical Bioethics, 1(3), 4–6.
44.Quill, T.E., Holloway, R.G. (2012). Evidence, Preferences, Recommendations—Finding the Right Balance in Patient Care. Obstetrical & Gynecological Survey, 67, 541–543.
45.Robinson, R. (2010). Registered nurses and moral distress. Dimensions of Critical Care Nursing, 29, 197-202.
46.Randall, F., Downie, R.S. (2010). The philosophy of palliative care. Critique and reconstruction. New York: Oxford University Press.
47.Rubin, S.B. (1998). When Doctors Say No. The Battleground of Medical Futility, Bloomington, Indianapolis: Indiana University Press.
48.Salter, E.K. (2020). The new futility? The rhetoric and role of ,,suffering” in pediatric decision-making. Nursing Ethics, 27(1),16–27.
49.Schneiderman, L.J. (2011). Defining futility and improving medical care. Journal of Bioethical Inquiry, 8, 123–131.
50.Schneiderman, L.J., Jecker, N.S., Jonsen, A.R. (1990). Medical futility: its meaning and ethical implications, Annals of Internal Medicine, 112, 949-954.
51.Schneiderman, L.J., Jecker, N.S. (2011). Wrong medicine. Doctors, patients and futile treatment. Baltimor: Johns Hopkins University Press.
52.Sibbald, R., Downar, J., Hawryluck, L. (2007). Perceptions of ‘futile care’ among caregivers in intensive care units. Canadian Medical Association Journal, 177,1201–1208.
53.Siewiera, J., Kübler, A. (2015). Terapia daremna dla lekarzy i prawników. Wrocław: Urban & Partner.
54.Smith, A.K., Glare, P. (2016). Ethical issues in prognosis and prognostication. In: Youngner, A.J., Arnold, R.M. (eds.), The Oxford Handbook of Ethics at the End of Life. New York: Oxford University Press, 170–189.
55.Sørensen, M., Andersen, L.W. (2019). Accepting the avoidable death: The philosophy of limiting intensive care. Bioethics, 33, 201–206.
56.Suchorzewska, J. (2013). Ból i cierpienie. In: Różyńska, J., Chańska, W. (eds.), Bioetyka. Warszawa: Wolters Kluwer, 191–203.
57.Suchorzewska, J. (2016). Wokół terapii daremnej – głos w dyskusji. Retrieved from: (26.01.2021).
58.Swetz, K.M., Burkle, Ch.M., Berge, K.H., Lanier, W.L. (2014). Ten Common Questions (and Their Answers) on Medical Futility. Mayo Clinic Proceedings, 89, 943–959.
59.Szeroczyńska, M. (2013). Odstąpienie od uporczywej terapii de lege lata i de lege ferenda. Medycyna Paliatywna, 2, 31–40.
60.Szewczyk, K. (2016), O medycznej daremności proceduralnej i o powodach, dla których należy ją włączyć w polskie regulacje bioetyczne i system prawny. Retrieved from: (04.01.2021).
61.Szewczyk, K. (2009). Bioetyka. Medycyna na granicach życia, Warszawa: Wydawnictwo PWN.
62.Terra, S.M., Powell, S.K. (2012). Is a determination of medical futility ethical? Professional Case Management, 17,103–106.
63.Truog, R.D., Brett, A.S., Frader, J. (1992). The problem with futility. The New England Journal of Medicine, 326, 1560-1564.
64.Van McCrary, S.V., Swanson, J.W., Youngner, S.J., Perkins, H.S, Winslade, W.J. (1994). Physicians’ Quantitative Assessments of Medical Futility. Journal of Clinical Ethics, 5, 100-105.
65.Vivas L., Carpenter, T. (2020). Meaningful futility: requests for resuscitation against medical recommendation. Journal of Medical Ethics. Doi:10.1136/medethics-2020-106232.
66.Veatch, R.M. (2013). So-Called Futile Care: The Experience of the United States. In: Bagheri, A. (ed.), Medical Futility. A Cross-National Study. London: Imperial College Press, 9–33.
67.Waisel, D., Truog, R. (1995). The cardiopulmonary resuscitation-not-indicated order: Futility revisited, Annals of Internal Medicine, 122, 304–308.
68.White, D.B., Pope, T.M. (2016). Medical futility and potentiality inappropriate treatment. In: Youngner, A.J., Arnold, R.M. (eds.), The Oxford Handbook of Ethics at the End of Life. New York: Oxford University Press, 65-86.
69.Wilkinson, D., Savulescu, J. (2019). Ethics, Conflict and Medical Treatment for Children. From Disagreement to Dissensus. London, Edinburg: Elsevier.
70.Wilkinson, D.J.C., Savulescu, J. (2011). Knowing when to stop: futility in the ICU. Current Opinion in Anaesthesiology, 24 (2), 160–165.
71.Younger, S.J. (2004). Medical futility. In: Encyclopedia of Bioethics, Post, S.G. (ed.), 3rd edition, vol. 3. New York: Macmillan Reference, 1718-1721.
72.Youngner, S.J. (1998). Who defines futility? Journal of the American Medical Association, 260 (14), 2094–2095.