Griener G G
Division of Bioethics, University of Alberta, Edmonton.
J Med Philos. 1995 Apr;20(2):207-24. doi: 10.1093/jmp/20.2.207.
The debate over futility is driven, in part, by physicians' desire to recover some measure of decision-making authority from their patients. The standard approach begins by noting that certain interventions are futile for certain patients and then asserts that doctors have no obligation to provide futile treatment. The concept of futility is a complex one, and many commentators find it useful to distinguish 'physiological futility' from 'qualitative futility'. The assertion that physicians can decide to withhold physiologically futile treatment generates little controversy. The claim that they can withhold qualitatively futile treatment runs afoul of standard objections to medical paternalism. There is reason to believe that the conceptual distinction will not be maintained in clinical practice. This paper contends that the scientific data which would support a physician's unilateral decision to withhold physiologically futile treatment also provide support for an institutional policy restricting access to the treatment. The data the doctor uses to take decision-making power out of the hands of the patient can be used by the administrator to take power out of the hands of the doctor. While this loss of power is unproblematic, there is reason to believe that the ambiguity in the term 'futility' will allow a much greater loss of physicians' power.
关于医疗无效性的争论，部分原因是医生希望从患者手中收回一定程度的决策权。标准方法首先指出某些干预措施对某些患者是无效的，然后断言医生没有义务提供无效治疗。无效性的概念很复杂，许多评论家发现将“生理无效性”与“定性无效性”区分开来很有用。医生可以决定不提供生理上无效的治疗这一说法几乎没有争议。他们可以不提供定性上无效的治疗这一说法则与对医疗家长主义的标准反对意见相冲突。有理由相信，这种概念上的区分在临床实践中不会得到维持。本文认为，支持医生单方面决定不提供生理上无效治疗的科学数据，也为限制获得该治疗的机构政策提供了支持。医生用来从患者手中夺取决策权的数据，管理者也可以用来从医生手中夺取权力。虽然这种权力的丧失没有问题，但有理由相信，“无效性”一词的模糊性将导致医生权力的更大丧失。
