I liked this article, because so much of the debate over futility and non-beneficial care is focused on the ICU. It is refreshing to examine the issues in a new context (burns). I also liked the following excerpt on definitions.
The philosopher Ludwig Wittgenstein once remarked that we cannot describe the sound of a clarinet, or the smell of a rose. No-one can describe the face of their partner in such detail that someone who never met them would be able to recognize them if they ran into them. But that does not imply we do not know them.
. . . . Futility decisions are much like Gestalt integrations. Recognizing a futile situation has often more similarity with recognizing a face than with applying a list of rules. That brings to the fore the question who is best qualified to recognize futility situations, and expertise must play a role in this.