Davis John K
J.D., Department of Philosophy, California State University, Fullerton, PO Box 6848, Fullerton, CA 92834, USA.
J Med Philos. 2008 Aug;33(4):356-73. doi: 10.1093/jmp/jhn019.
Most discussions of medical futility try to answer the Futility Question: when is a medical procedure futile? No answer enjoys universal support. Some futility policies say that the health care provider will answer this question when the provider and patient (or surrogate decisionmaker) cannot agree. This raises the Decision Question: who has the moral authority to decide what to do in cases where futility is disputed? I look for a procedural answer to this question, an answer that does not turn on whether a given party happens to answer the Futility Question correctly. I argue that these policies get it right; the provider should decide because providers have a right of conscientious refusal that extends to refusing procedures on grounds of futility. This is a procedural answer because providers have this right even if they are sincerely mistaken about whether a procedure is futile.
医疗程序何时是无效的？没有一个答案能得到普遍支持。一些无效性政策规定，当医疗服务提供者与患者（或替代决策者）无法达成一致时，由医疗服务提供者来回答这个问题。这就引出了决策问题：在无效性存在争议的情况下，谁有道德权威来决定该怎么做？我寻求这个问题的程序性答案，即一个不取决于某一方是否碰巧正确回答了无效性问题的答案。我认为这些政策是正确的；应该由医疗服务提供者来决定，因为医疗服务提供者有基于良心拒斥的权利，这种权利延伸至以无效性为由拒绝实施医疗程序。这是一个程序性答案，因为即使医疗服务提供者在某一程序是否无效的问题上真诚地犯了错误，他们仍然拥有这项权利。
