Situations in which the patient’s family seems not to be acting in good faith or the patient's suffering is uncontrollable are relatively rare and do not warrant giving physicians unilateral power to withhold or withdraw treatment in all cases of perceived medical futility.
Forcing parents to participate in treatment is unlikely to succeed. Seeking to optimize the therapeutic alliance between family and pediatrician is more likely to achieve the desired outcome—the child’s short- and long-term well-being.
Patients who use drugs intravenously may be at high risk for relapse, but their situation is no more futile than that of persons with diabetes and coronary artery disease who smoke and frequent all-you-can-eat buffets.