Lantos J D, Singer P A, Walker R M, Gramelspacher G P, Shapiro G R, Sanchez-Gonzalez M A, Stocking C B, Miles S H, Siegler M
Center for Clinical Medical Ethics, La Rabida Children's Hospital and Research Center, Chicago, Illinois 60649.
Am J Med. 1989 Jul;87(1):81-4. doi: 10.1016/s0002-9343(89)80487-5.
The claim that a treatment is futile is often used to justify a shift in the physician's ethical obligations to patients. In clinical situations in which non-futile treatments are available, the physician has an obligation to discuss therapeutic alternatives with the patient. By contrast, a physician is under no obligation to offer, or even to discuss, futile therapies. This shift is supported by moral reasoning in ancient and modern medical ethics, by public policy, and by case law. Given this shift in ethical obligations, one might expect that physicians would have unambiguous criteria for determining when a therapy is futile. This is not the case. Rather than being a discrete and definable entity, futile therapy is merely the end of the spectrum of therapies with very low efficacy. Ambiguity in determining futility, arising from linguistic errors, from statistical misinterpretations, and from disagreements about the goals of therapy, undermines the force of futility claims. Decisions to withhold therapy that is deemed futile, like all treatment choices, must follow both clinical judgments about the chance of success of a therapy and an explicit consideration of the patient's goals for therapy. Futility claims rarely should be used to justify a radical shift in ethical obligations.
声称某种治疗是无效的，这一说法常常被用来为医生对患者的道德义务转变提供正当理由。在存在非无效治疗方法的临床情况下，医生有义务与患者讨论治疗方案。相比之下，医生没有义务提供甚至讨论无效的治疗方法。这种转变得到了古代和现代医学伦理中的道德推理、公共政策以及判例法的支持。鉴于这种道德义务的转变，人们可能会期望医生有明确的标准来确定一种治疗何时是无效的。但实际并非如此。无效治疗并非一个离散且可定义的实体，而仅仅是疗效极低的治疗方法范围的终点。由于语言错误、统计误解以及对治疗目标的分歧而导致的确定无效性的模糊性，削弱了无效性主张的说服力。决定停止被认为无效的治疗，与所有治疗选择一样，必须既依据对治疗成功可能性的临床判断，又要明确考虑患者的治疗目标。无效性主张很少应用来为道德义务的根本转变提供正当理由。
