FUTILITY AND THE VARIETIES OF MEDICAL JUDGMENT

Pellegrino has argued that end-of-life decisions should be based upon the physician's assessment of the effectiveness of the treatment and t he patient's assessment of its benefits and burdens. This would seem t o imply that conditions for medical futility could be met either if th ere were a judgment of ineffectiveness, or if the patient were in a st ate in which he or she were incapable of a subjective judgment of the benefits and burdens of the treatment. I argue that a theory of futili ty according to Pellegrino would deny that latter but would permit som e cases of the former. I call this the ''circumspect'' view. I show th at Pellegrino would adopt the circumspect view because he would see th e medical futility debate in the context of a system of medical ethics based firmly upon a philosophy of medicine. The circumspect view is c hallenged by those who would deny that one can distinguish objective f rom subjective medical judgments. I defend the circumspect view on the basis of a previously neglected aspect of the philosophy of medicine - an examination of varieties of medical judgment. I then offer some p ractical applications of this theory in clinical practice.