The concepts of medical futility and "potentially inappropriate" interventions aim to describe particular decision-making situations and assist in making ethically sound decisions. This article explores how both of these concepts simplify the rather more complicated decision-making task in ways that often hinder their ability to be helpful, and potentially allow for unstated biases to influence decisions. Instead of searching for a single unifying phrase or concept, acknowledging and explicitly working with the numerous judgments and decisions that comprise a high-stakes medical treatment decision will do more to advance ethically sound decision-making.