Wilson Bradley E
Bioethics. 1996 Jan;10(1):43-55. doi: 10.1111/j.1467-8519.1996.tb00102.x.
It is becoming increasingly common (at least in the United States) for doctors to appeal to futility judgments as the basis for certain types of clinical decisions, such as the decision to withhold CPR. The clinical use of futility judgments raises two basic questions regarding futility. First, how is the concept of futility to be understood? Secondly, once we have a clearer understanding of futility, what role should determinations of futility play in clinical decision-making? Much of the discussion about the concept of futility has centered on the value-ladenness of futility judgments. I argue that futility determinations need to be distinguished from two other types of value-based judgments, namely, identification of the goals of treatment and treatment decisions based on an assessment of the benefits and burdens of treatment. If this distinction is sound, it suggests a very limited role for futility determinations in clinical decision-making, a role which should serve to promote communication between doctor and patient.
医生将无效判断作为某些类型临床决策（如决定不进行心肺复苏）的依据，这种情况正变得越来越普遍（至少在美国是这样）。无效判断在临床中的应用引发了关于无效的两个基本问题。第一，如何理解无效的概念？第二，一旦我们对无效有了更清晰的理解，无效判定在临床决策中应扮演什么角色？关于无效概念的许多讨论都集中在无效判断的价值负载性上。我认为，无效判定需要与其他两种基于价值的判断区分开来，即确定治疗目标以及基于对治疗益处和负担的评估做出治疗决策。如果这种区分合理，那么它表明无效判定在临床决策中的作用非常有限，其作用应是促进医患之间的沟通。
