Thank you for Lisa Day’s article, “Medical Futility, Personal Goods, and Social Responsibility.”11 She correctly characterizes medical futility disputes as increasingly common due to growth of both the critical care population and the range of deployable life-sustaining medical technology.

However, Day’s optimistic assessment of current mechanisms for handling these intractable futility disputes is misplaced. Day writes that when a patient or surrogate requests treatment that the provider determines is inconsistent with the goals of medicine or with his or her conscience, then, unless consensus can be reached, the treatment relationship should be “dissolved” and the patient should look for a new provider. As reflected in its wide adoption in institutional futility policies, transfer appears to be a satisfactory compromise solution: it allows the current provider to avoid providing inappropriate treatment and allows the patient to get the treatment that he or...

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