Physicians must not offer futile treatments, patients must not request it, and insurers must not pay for it. However, controversy rages about who determines futility and what criteria to use. Two opposing comments are listed below:

'Preservation of the integrity of the medical profession requires that the physician determines the futility of treatment relative to the goals of the medical practice."

:"Avoiding medical paternalism requires the patients or their surrogates determine futility relative to personal criteria."

In short, futility means that either a treatment will not have any consequences that are beneficial to the patient or the likelihood of benefit is too remote to make the intervention worth undertaking.

It is difficult for patients and surrogates to fully appreciate the ways in which medical interventions impact on quality of life. Conversely, the physician possesses a rich clinical appreciation for the impact of these interventions on the quality of life can provide better judgements. However, unilateral decision by the physician has its own shortcoming. A better model would be the physician acts as an advisor who counsels the patients or the surrogates. Physicians and patients or surrogates almost agree about the the futility of a treatment if there has been careful and complete conversation about treatment goals that are both achievable and desirable.  When there is initial disagreement , it can usually be resolved if therapeutic goals are reviewed , factual misunderstandings are corrected, affective constraints are ameliorated, and the consequences of treatment fully appreciated.