Professor Moratti (UniversityofGroningen) has a new article on medical futility in theJune 2009 issueof theJournal of Medical Ethics,titled "The Development of 'Medical Futility': Towards a Procedural Approach Based on the Role of the Medical Profession."I particularly like his use of the term “abstention decision” to refer to the refusal of interventions requested by a patient or surrogate.

Professor Moratti provides a nice history of the function of the notion of "futility." But he seems to ignore this very history when he moves from the descriptive to the normative section of his article.

Looking to theUSA, Professor Moratti rightly observes that there has been a major shift to a "procedural" approach to medical futility disputes. But he mischaracterizes exactly what that approach entails. In defining the circumstances under which an "intervention should not be performed," Professor Moratti refers to "general consensus in the medical community," "professional standards," and "criteria of appropriateness."

But it is precisely the inability to reach a professional (or broader social) consensus on such standards or criteria that motivated the shift to a procedural approach in the first place. As now employed in theUSA, the procedural approach is one of "pure" process. The validity of the "abstention decision" is determined by the fairness of the method through which the decision is reached, without reference to external substantive standards or criteria. Indeed, without consensus on fine-grained principles capable of resolving disputes, resort to pure process is the only workable mechanism.