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Futility and neurotrauma: can we make an objective assessment?

Stephen Honeybul, Kwok M Ho, Grant R Gillett, Christopher R P Lind and Susan O’Hanlon
Med J Aust 2012; 196 (8): . || doi: 10.5694/mja11.11485
Published online: 7 May 2012

How do decisions change if we can assess risk of “unacceptable badness”?

The concept of medical futility has been debated for many years, but a precise definition remains elusive.1-3 This is not surprising given the evolving nature of modern medicine. Progressively more complex decisions are required when considering increasingly sophisticated diagnostic and therapeutic interventions. Providing a simple definition as to when treatment should be withheld or withdrawn may be unrealistic.


  • 1 Sir Charles Gairdner Hospital, Perth, WA.
  • 2 Royal Perth Hospital, Perth, WA.
  • 3 Otago Bioethics Centre, University of Otago, Dunedin, New Zealand.



Competing interests:

No relevant disclosures.

  • 1. Helft PR, Siegler M, Lantos J. The rise and fall of the futility movement. N Engl J Med 2000; 343: 293-296.
  • 2. Schneiderman LJ, Jecker NS, Jonsen AR. Medical futility: its meaning and ethical implications. Ann Intern Med 1990; 112: 949-954.
  • 3. Chwang E. Futility clarified. J Law Med Ethics 2009; 37: 487-495.
  • 4. Gillet GR. Minimally conscious states, deep brain stimulation, and what is worse than futility. J Bioeth Inq 2011; 8: 145-149. doi: 10.1007/s11673-011-9292-4.
  • 5. Gillett GR, Honeybul S, Ho KM, Lind CR. Neurotrauma and the RUB: where tragedy meets ethics and science. J Med Ethics 2010; 36: 727-730.
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  • 7. Honeybul S, Ho KM, Lind CR, Gillett GR. Observed versus predicted outcome for decompressive craniectomy: a population-based study. J Neurotrauma 2010; 27: 1225-1232.
  • 8. Honeybul S, Ho KM, Lind CR, Gillett GR. Decompressive craniectomy for diffuse cerebral swelling after trauma: long-term outcome and ethical considerations. J Trauma 2011; 71: 128-132.
  • 9. MRC CRASH Trial Collaborators; Perel P, Arango M, Claydon T, et al. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ 2008; 336: 425-429.
  • 10. Honeybul S, O’Hanlon S, Ho KM, Gillett G. The influence of objective prognostic information on the likelihood of informed consent for decompressive craniectomy: a study of Australian anaesthetists. Anaesth Intensive Care 2011; 39: 659-665.

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