Truog Robert D
Perspect Biol Med. 2018;60(3):428-432. doi: 10.1353/pbm.2018.0019.
Debate about the concept of medical futility is often polarized around two views. One is that futility is simply an acknowledgment of the limitations of modern medicine, a corollary of the fact of human mortality. The other is that futility is a judgment that is always grounded in a particular set of values, and that medical professionals have no right to impose their value judgments on patients and families who do not share their perspective. This essay argues that these dichotomous views can be reconciled by appreciating the importance of the context in which the dialogue occurs. When clinicians and families are working collaboratively in a process of shared decision-making, use of the concept of futility in the former sense can be an effective way of capturing the limits of medicine. When communication and trust have broken down and the parties are engaged in a process of conflict resolution, the latter interpretation of futility is necessary in order to demonstrate respect for those who embrace a different set of values and perspectives.
关于医疗无效性概念的争论往往集中在两种观点上。一种观点认为，无效性仅仅是对现代医学局限性的一种认知，是人类必死这一事实的必然结果。另一种观点则认为，无效性是一种总是基于特定价值体系的判断，并且医学专业人员无权将他们的价值判断强加于那些与他们观点不同的患者和家属身上。本文认为，通过认识到对话发生的背景的重要性，这两种二分法观点可以得到调和。当临床医生和家属在共同决策过程中进行合作时，从前者意义上使用无效性概念可以是一种有效把握医学局限性的方式。当沟通和信任破裂且各方参与冲突解决过程时，为了表明对那些持有不同价值体系和观点的人的尊重，对无效性的后一种解释是必要的。
