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In modern medicine, futilitarianism (futility + utilitarianism, I believe) is the practice of refusing treatment to a patient when the physician deems it a useless effort. Needless to say, futilitarianism, sometimes called futile care theory, raises an enormous amount of ethical questions and is viciously opposed by disability advocates, who liken it to "medical fascism." Its implications are particularly troubling in the context of managed care, in which the decision to extend a patient's life literally rests in the hands of a corporation which allows individual physicians and patients little autonomy to make unprofitable ethical choices.

Futilitarianism is also used in politics, though it is less common there than in medicine. Political futilitarianism generally arises from a libertarian outlook: the government is hopelessly corrupt and incompetent in the things it already does, so enlarging it and increasing its functions must be a wasted effort.

The word was probably first used to describe the personal philosophy of H.P. Lovecraft, by his biographer L. Sprague De Camp in 1975. Lovecraft, having fallen from a privileged, aristocratic childhood to relative poverty, regarded himself as a gentleman in a reactionary, 18th-century sense. This viewpoint conspired with his deep-seated pessimism, leaving him to disdain the idea of writing for financial gain, preferring the personal satisfaction of creative autonomy and obscurity to popular acclaim and wealth. After all, if what you do doesn't make a bit of difference in the larger scheme of things, wouldn't it be best to work at something that allowed you to keep your own pride and integrity?

The great irony here, of course, is that Lovecraft's futilitarian worldview led him to express a personal genius that remains unequaled to this day, while his competitive, profit-driven contempories created popular fluff whose renown was as ephemeral as Lovecraft's wealth.

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