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Abstract
It seems more than coincidental that at a time of great concern over rising health
care costs and fears of rampant technology, debates are suddenly taking place about
medical futility and health care rationing. This article examines the economic, historical,
and demographic factors that have motivated increased attention to both these concepts,
explores differences and similarities in the meaning of these terms, and discusses
their ethical implications. Specifically, we identify four common sources of current
debates on futility and rationing: the rise in health care costs; the development
of high-technology medicine; the aging of society; and the effort to limit the scope
of patient autonomy. We propose that when rationing criteria refer to medical benefit,
the meanings of futility and rationing share certain common features. Futility and
rationing differ, however, in important ways. Futility refers to treatment and outcome
relationships not in a general population but in a specific patient. Rationing criteria
usually are supported by reference to theories of justice, whereas the definition
of futility, if achieved, will probably be arrived at by empirical community agreement.
Rationing always occurs against a backdrop of resource scarcity, but futility need
not. Toward the end of the paper, we clarify how the various connotations and contexts
we associate with each term enhance or frustrate ethical debate.