Physiologic and Probabilistic Futility Medical

Physiologic and Probabilistic Futility

Medical Ethics

There are a number of key distinctions between probabilistic futility and physiologic futility -- both of which have the potential to play important roles in the values and ethical decisions required for patients near the end of their lives. Furthermore, the difference between these terms and the concepts they denote can significantly affect the types of treatments offered to patients and their families who find themselves within these respective situations. Therefore, it greatly behooves medical students to be able to define these terms in their own words to gauge a proper understanding of the ethical obligations mandated by these situations.

Both probabilistic and physiologic futility are part of the many-faceted forms of medical futility that can be considered predictive, primarily since the lack of effectiveness of a particular treatment has not been determined when these situations arise. Both of these situations can be contrasted with what is known as post-hoc futility, where a treatment has already been administered and has proven to be a failure (Walker 1999). Yet the primary difference between probabilistic futility and physiologic futility can be found in the degree of hopelessness of a particular medical treatment or condition. In the case of probabilistic futility, the probability of the success of a treatment or one which would significantly improve a situation is excessively low. However, by the very virtue of the fact that the probability of success for a particular treatment is so low, it is not impossible -- meaning that in some respect hope may exist for a particular patient, despite the fact that such hope is highly unlikely.

It is the likelihood of hope for success in a particular medical treatment that largely distinguishes physiologic futility from probabilistic futility. In situations in which there is physiologic futility, there is no chance for success with a particular operation of medical procedure in terms of benefiting the patient who will undergo these measures. The futility of this situation is readily confirmed and there is essentially no need to perform whatever medical procedure is being considered to possibly have a curative effect upon the patient. This form of medical futility can be stratified into two separate varieties, the first of which is referred to as medical nonsense, while the second of which is called medical impasse (Walker 1999). Medical nonsense refers to procedures or options which have been previously confirmed by general medical practitioners to not have any sort of restorative effect for a certain condition, such as prescribing cough medicine for someone who is suffering from a fatal case of HIV. Typically, cases of probabilistic futility that may be considered medical nonsense actually have a potential for harming, instead of helping the patient, based upon which "nonsensical" medical procedure is selected. The more complicated of the two forms of medical futility situations, medical impasse physiologic futility occurs in cases in which physiologically, there has been too much damage incurred (from a variety of sources to a wide variety of places within the body) and procedures that would normally benefit a patient suffering from one particular condition will not help a specific patient whose' condition has been considerably exacerbated by additional symptoms or forms of duress. Still, the unifying factor that is prevalent in both types of physiologic futility is that there is absolutely no chance of recovery or of beneficence to be gained by a particular procedure.

Due to the varying nature of both forms of medical futility, probabilistic and physiologic, the way medical practitioners should deal with these respective situations varies accordingly. In terms of the treatment of probabilistic futility, such practitioners must take account the fact that no matter how remote, there is a possibility of beneficence to be gained by a procedure which is being considered either by the patient or by his family, and must act accordingly. Therefore, a physician or medical staff should not be the sole determinant of a whether such a procedure is undertaken. Instead, medical personnel should consult with either the patient or with his or her family to come to a consensus of opinions -- ideally with plans for contingency -- regarding whether or not a particular procedure should be formed. The values of all parties should be examined, because they may not all be congruent with one another, particularly the perspective of the medical practitioners and those of the patient's family.