Background:
Empirical surveys about medical futility are scarce relative to its theoretical assumptions. Weaimed to evaluate the difference of attitudes between laypeople and physicians towards theissue.
Methods:
A questionnaire survey was designed. Japanese laypeople (via Internet) and physicians withvarious specialties (via paper-and-pencil questionnaire) were asked about whether they wouldprovide potentially futile treatments for end-of-life patients in vignettes, important factors forjudging a certain treatment futile, and threshold of quantitative futility which reflects thenumerical probability that an act will produce the desired physiological effect. Also, thephysicians were asked about their practical frequency and important reasons for futiletreatments.
Results:
1134 laypeople and 401 (80%) physicians responded. In all vignettes, the laypeople weremore affirmative in providing treatments in question significantly. As the factors for judgingfutility, medical information and quality of life (QOL) of the patient were rather stressed bythe physicians. Treatment wish of the family of the patient and psychological impact onpatient side due to the treatment were rather stressed by laypeople. There were widevariations in the threshold of judging quantitative futility in both groups. 88.3% of thephysicians had practical experience of providing futile treatment. Important reasons for itwere communication problem with patient side and lack of systems regarding futility orforegoing such treatment.
Conclusion:
Laypeople are more supportive of providing potentially futile treatments than physicians. Thedifference is explained by the importance of medical information, the patient family’sinfluence to decision-making and QOL of the patient. The threshold of qualitative futility issuggested to be arbitrary.