An Act of Futility, or Pascal’s Wager?

Abstract

Futility is defined as something unimportant, useless, ineffective, without value or purpose, frivolousness, unable to solve problems. The definition of futility is clear and simple; the difficultly is its clinical application in the management of complex cases. The implications are different when dealing with medical or surgical patients. It is radically different when the decision of not doing any other efforts for the treatment of intractable heart failure or disseminated carcinomatosis or when we are dealing with surgical patients whose diseases carry very low opportunity of survival or of improvement in his general wellbeing. It is in the medical cases that the strategy of hanging the Crepe is used when trying to communicate to the relatives the gravity of their beloved ones illness. At times the physicians exaggerate the seriousness of the disease to lessen the suffering if eventually the patient dies. Crepe is a black piece of cloth forming a bow that used to be placed in the front door of the house to indicate the death and mourning of the relatives. This custom has been abandoned in almost all countries. Physicians undertake the utmost efforts in trying to preserve the life of their patients as well as to provide quality of life no matter the economic circumstances. In recent years I had two patients who were so sick that their condition gave the impression that their lives were close to an end. Nevertheless, after an operation deemed by some other physicians as futile, both patients recovered and are leading a normal lives for the past six and five years respectively.