82 Journal of Pediatric Ethics Winter 2019 ABSTRACT The primary purpose of this article is to critically examine the state of the medical ethics literature and discourse around the concept of futility in pediatric intensive or critical care. The second- ary purpose is to identify the conceptualization of futility by differ- ent authors, the tensions that exist in the discourse around futility, and the variables that exist in cases when futility is thought to occur. Identification of concepts, tensions, and variables will help to identify the social structure around issues of futility in pediatric intensive care. Seventeen articles were included for summative content analysis. Four conceptions of futility were found: unclear, against medical standards, a subjective value judgment, and not a unilateral conception. The major tensions that emerged, in order, were that futility is based in relationships and responsibility, is goal oriented, and based in beliefs and values. The most reported vari- able was conflict between parents and careproviders, followed by mechanical ventilation, neurologic devastation, terminal illness, un- certainty, and aggressive treatment. Given that the main variable found was conflict, the main tension was relational, and no con- sensus on futility was found, it appears that unless there is inves- tigation into the mechanisms of conflict and relational tensions A Critical Analysis of Futility Discourse in Pediatric Critical Care Ian Wolfe Ian Wolfe, RN, CCRN, is a Charge Nurse and a Staff Nurse at Children’s Hospital of Minnesota, is a PhD Candidate in the Nurs- ing Department at the University of Minnesota, and is an MA Stu- dent in the Center for Bioethics at the University of Minnesota in Minneapolis, Minnesota. wolfe370@umn.edu ©2019 by Journal of Pediatric Ethics. All rights reserved. around futility, this phenomenon will continue to appear in the medical ethics literature. INTRODUCTION This article is a summary of a critical literature review performed as a preliminary written exam for a doctoral dissertation. The purpose of the review was to analyze the medical ethics literature that ex- ists on futility in pediatric intensive care. The aim was to identify the mechanisms, relations, objects, and structures that must be present for cases of fu- tility, or disputes around futility, to come into be- ing. The review specifically looked at the medical ethics literature in an attempt to identify themes in the conceptualization of futility and the roles in- volved in and around futility, and to isolate the struc- tures around futility in pediatric intensive care. There is a need to identify the structures around cases of futility to understand why they happen. In this case, structure refers to and encompasses the systems, components, relationships, and processes that surround and affect a phenomenon. Andrew Sayer, a social scientist working in realist philoso- phy, conceptualized structure as “a set of internally related objects or practices.” 1 Geoff Easton noted that related objects or practices can include departments, people, processes, and/or resources. 2 This is simi- larly conceived by systems theorists who view a system as “a perceived whole,” the elements of