Ardagh M
Christchurch School of Medicine, New Zealand.
J Med Ethics. 2000 Oct;26(5):396-9. doi: 10.1136/jme.26.5.396.
"Futility" is a word which means the absence of benefit. It has been used to describe an absence of utility in resuscitation endeavours but it fails to do this. Futility does not consider the harms of resuscitation and we should consider the balance of benefit and harm that results from our resuscitation endeavours. If a resuscitation is futile then any harm that ensues will bring about an unfavourable benefit/harm balance. However, even if the endeavour is not futile, by any definition, the benefit/harm balance may still be unfavourable if the harms that ensue are great. It is unlikely that we will ever achieve a consensus definition of futility and certainly not one that is applicable to every patient undergoing resuscitation. In the meantime our use of the term "futile", in the mistaken belief that it tells us whether it is worth resuscitating or not, has no utility as it will never succeed in telling us this. Furthermore we risk causing offence by use of the term and we risk harming the patient's autonomy by using futility as an overriding force. Instead we should consider the utility of our endeavours, for which an assessment of the harms of resuscitation should be added to our considerations of its benefit. This balance of benefit and harm should then be evaluated as best it can be from the patient's perspective. The words futile and futility should be abandoned by resuscitationists.
“无效”一词意味着没有益处。它曾被用于描述复苏努力中缺乏效用的情况，但它并不能做到这一点。无效没有考虑到复苏的危害，而我们应该考虑复苏努力所带来的利弊平衡。如果一次复苏是无效的，那么随之而来的任何危害都会导致不利的利弊平衡。然而，即使按照任何定义，这种努力并非无效，但如果随之而来的危害很大，利弊平衡可能仍然不利。我们不太可能达成一个关于无效的共识定义，当然也不可能有一个适用于每一位接受复苏的患者的定义。与此同时，我们使用“无效”这个词，错误地认为它能告诉我们是否值得进行复苏，其实并无用处，因为它永远无法成功地告诉我们这一点。此外，我们使用这个词可能会冒犯他人，并且我们冒着以无效作为首要因素来损害患者自主权的风险。相反，我们应该考虑我们努力的效用，为此，在考虑复苏益处的同时，应该增加对复苏危害的评估。然后，应该尽可能从患者的角度评估这种利弊平衡。复苏人员应该摒弃“无效”和“无效性”这两个词。
