The counselling and support of patients and their relatives in situations where medical treatment may be ineffective is an inherent task of medicine. Often this topic is described by the generic concept of medical futility. The SAMS provides guidance with recommendations and specific case studies.
It is up to healthcare professionals to evaluate, on the basis of scientific data and experience, whether a therapy is indicated or, on the contrary, whether it appears ineffective and/or offers little or no likelihood of benefit. This process, which involves a case-by-case assessment, is never free from subjectivity, since it is influenced by the value judgments of patients, their relatives, and healthcare professionals. Involved professionals bear a special professional and ethical responsibility. They may also feel compelled to carry out treatments even though, in their view, these are not in the patient's best interests, for example due to pressure from the patient or their relatives.
Several medical-ethical guidelines of the SAMS deal with situations of ineffectiveness or unlikelihood of benefit. In view of the discussions on this topic, which intensified during the Covid-19 pandemic, the Central Ethics Committee (CEC) of the SAMS decided to address this topic in-depth and to set up a subcommittee. The results of this work were published in trilingual recommendations entitled «Ineffectiveness and unlikelihood of benefit: dealing with the concept of futility in medicine» (2021).
Recommendations on ineffectiveness and unlikelihood of benefit
Eight recommendations with examples
In addition to the theoretical background, which critically examines the concept of futility, the publication illustrate concrete case studies. The SAMS thus offers practical advice in the hope that this approach will lead to a fundamental reflection on how to deal with ineffectiveness and unlikelihood of benefit in medicine. The SAMS invites professional associations, healthcare organizations, and patient associations to engage in a debate on this complex topic. Of the eight recommendations in total, one is listed below as an example.
Recommendation «Defining the goal of treatment»: the overarching goal of treatment must be jointly defined with the patient or their representatives. In this context, healthcare professionals should take into account the consideration and knowledge of the patients, listen to their needs, wishes and fears, and enquire about the patient’s preferences. Professionals are to be guided by the treatment goal and to assess whether the procedure corresponds to this goal. The outcome must be properly documented.
Example: A patient with cervical cancer develops obstructive kidney failure, which, if left untreated, can be rapidly fatal. The patient would like to live to see the birth of her grandchild in two months’ time. Dialysis can extend life without, however, affecting the underlying malignancy. As it makes it possible for the patient to live to see her grandchild born, it may be appropriate.
Futility from different perspectives
Case study
In the «5 minutes pour apprendre» section of the Journal Revue Médicale Suisse, a case study is used to show how (impending) futility can be recognised and avoided in practice. The eight recommendations from the SAMS publication are reflected upon and concretised in a step-by-step manner using the example of a 79-year-old patient.
Futility in psychiatry
While the concept of therapeutic futility is well established in somatic medicine, questions surrounding ineffectiveness and futility in psychiatric care have hardly been systematically addressed to date. However, explicitly addressing benefits, burdens and treatment goals is just as crucial in psychiatric care. An international and interdisciplinary group of experts has bridged this gap and published a consensus statement in 2026. The article shows that qualitative futility in particular – understood as weighing up benefits and burdens while taking into account the goals and values of those affected – offers a helpful framework for orientation. At the same time, clear processes, careful communication and ethical guidelines are also crucial. The article is available online as open access publication.