The gynecologic oncologist and futile therapy in a managed care setting.

The concept of futility is basic to the provision of ethical medical care. The precise definition has been elusive for medical ethicists because of difficulties in trying to "measure" futility, either by "quality" or by "quantity." The change in health care from a fee-for-service basis to one of managed care has added to the dilemmas posed by the requests of patients for care that physicians consider futile. However, using the concept of medical indications and clinical pathways may lead to resolutions of these medical-ethical dilemmas.