Futility Disputes: A Review of the Literature and Proposed Model for Dispute Navigation Through Trust Building

J Intensive Care Med. 2017 Oct;32(9):523-527. doi: 10.1177/0885066616666001. Epub 2016 Aug 27.


Futility disputes in the intensive care unit setting have received significant attention in the literature over the past several years. Although the idea of improving communication in an attempt to resolve these challenging situations has been regularly discussed, the concept and role of trust building as the means by which communication improves and disputes are best navigated is largely absent. We take this opportunity to review the current literature on futility disputes and argue the important role of broken trust in these encounters, highlighting current evidence establishing the necessity and utility of trust in both medical decision-making and effective communication. Finally, we propose a futility dispute navigation model built upon improved communication through trust building.

Keywords: communication; decision-making; disagreement; end-of-life care; futility; perceptions; trust.

Publication types

  • Review

MeSH terms

  • Clinical Decision-Making
  • Communication
  • Critical Care / psychology*
  • Dissent and Disputes*
  • Humans
  • Intensive Care Units
  • Medical Futility*
  • Trust*