Choices in Uncertainty

A simple maxim for clinical ethics could read, “meaning well and doing good,” or “making treatment choices that integrate sensible medical options with the individual patient’s wishes and values.” With respect to this goal, optimal decision-making should be based on a combination of sound medical practice, clinicians’ personal virtues, shared decision-making both within the team and between the team and the patient/family, and strong team leadership. However, a Sisyphus-like struggle for certainty is increasingly counteracting achieving the objective of realistic, goal-oriented care decisions and their subsequent implementation. What we believe is needed is a cultural change toward accepting uncertainty as an integral component of the landscape of disease, decision-making, and treatment—rather than an obstacle that needs to be overcome.