The parkland approach to demands for "futile" treatment

Recent literature in medical ethics has emphasized disputes concerning the relative usefulness or uselessness (futility) of medical treatments. In our institution, these disputes typically arise in the context of critical care, with patients or families requesting or demanding a treatment (such as cardiopulmonary resuscitation) that in the treating physician's view holds no promise of benefit. In the context of revising our general treatment refusal/withdrawal/withholding guidelines, we provided a structure for resolving such disputes in a manner that balances the often conflicting goods of patient/family autonomy, physician autonomy, and institutional responsibility.