The family wants everything done: a reasonable justification for futile surgery? Illustrative case.

backgroundThere is a consensus that withholding aggressive medical care in medically futile situations is ethically sound, even if the patient, surrogate, or family wants everything done. The authors aim to evaluate and discuss the situations in which this request is used as justification for intervention, specifically lifesaving surgery, when a situation is defined by a futile outcome. OBSERVATIONS: The authors utilize the illustrative case of an older female who presented with a traumatic brain injury and Duret hemorrhage, an unfortunately common scenario faced by neurosurgeons, to discuss the complex ethical and practical implications of these situations. They seek to define futility, provide an overview of basic medical ethical principles, and evaluate both the motivation to operate and the educational gaps among patients, families, and providers. LESSONS: Review of the basic principles of medical ethics lends to the conclusion that the demands of a patient's family are not adequate justification for surgical intervention in cases, such as the present one, in which a patient is unlikely to benefit. Education and communication are common challenges of managing futile situations and present an educational opportunity for resident physicians. https://thejns.org/doi/10.3171/CASE25212.