Crit Care Med. 1997 May;25(5):887-91. doi: 10.1097/00003246-199705000-00028.
Society must always face the reality of limited medical resources and must find mechanisms for distributing these resources fairly and efficiently. One recent approach for distributing limited medical resources has been the development of policies that limit the availability of futile treatments. The objectives of this consensus statement are as follows: a) to define futility and thereby enable a clear discussion of the issues; and b) to identify principles and procedures for resolving cases in which life-sustaining treatment may be futile or inadvisable.
A literature review, synthesis, and committee discussion.
Treatments should be defined as futile only when they will not accomplish their intended goal. Treatments that are extremely unlikely to be beneficial, are extremely costly, or are of uncertain benefit may be considered inappropriate and hence inadvisable, but should not be labeled futile. Futile treatments constitute a small fraction of medical care. Thus, employing the concept of futile care in decision-making will not primarily contribute to a reduction in resource use. Nonetheless, communities have a legitimate interest in allocating medical resources by limiting inadvisable treatments. Communities should seek to do so using a rationale that is explicit, equitable, and democratic; that does not disadvantage the disabled, poor, or uninsured; and that recognizes the diversity of individual values and goals. Policies to limit inadvisable treatment should have the following characteristics: a) be disclosed in the public record; b) reflect moral values acceptable to the community; c) not be based exclusively on prognostic scoring systems; d) articulate appellate mechanisms; and e) be recognized by the courts. Healthcare organizations that control payment have a profound influence on treatment decisions and should formally address criteria for determining when treatments are inadvisable and should share accountability for those decisions.
社会必须始终面对医疗资源有限的现实，必须找到公平且高效分配这些资源的机制。最近一种分配有限医疗资源的方法是制定限制无效治疗可及性的政策。本共识声明的目标如下：a）定义无效性，从而能够对相关问题进行清晰的讨论；b）确定解决维持生命治疗可能无效或不可取情况的原则和程序。
文献综述、综合分析及委员会讨论。
仅当治疗无法实现其预期目标时，才可将其定义为无效。极不可能有益、成本极高或益处不确定的治疗可被视为不适当，因此不可取，但不应被标记为无效。无效治疗在医疗护理中占比很小。因此，在决策中采用无效护理的概念不会主要有助于减少资源使用。尽管如此，社区通过限制不可取的治疗来分配医疗资源是合理的。社区应寻求以明确、公平和民主的理由来这样做；该理由不应使残疾人、穷人或未参保者处于不利地位；并应认识到个人价值观和目标的多样性。限制不可取治疗的政策应具有以下特点：a）在公共记录中披露；b）反映社区可接受的道德价值观；c）不 solely基于预后评分系统；d）阐明上诉机制；e）得到法院认可。控制支付的医疗保健组织对治疗决策有深远影响，应正式确定确定治疗何时不可取的标准，并应对这些决策承担责任。
