Tuesday, April 1, 2008

On Uncertainty

There's someone in my close circle who is undergoing chemotherapy. This week we are confronted with yet another of the many decisions that need to be made along the way. Actually, seen from the narrowest perspective of the chemicals and the illness and the interaction between them, there shouldn't be much of a deliberation; the situation is pretty clear. But then you factor in other imponderables, such as the physical condition of the person, and then their frame of mind. The physical condition can be mostly measured, sort of; the frame of mind, which is probably far more important, can't really be measured at all, not in any scientific way. And then there are other legitimate considerations: the time of year, the shifts at the hospital, this that and the other. Pretty soon, what started out as a simple equation is anything but.

Then there are the questions of who makes the decision, and by which criteria. At an earlier stage, many months ago, we learned that expert number one in North America would have had a clearcut opinion about the deliberation we were facing at that time, but that his position would have been the opposite of that of the entire relevant medical establishment in Germany; the person telling us is himself a world renowned expert, and he was telling as an explanation for his own uncertainty.

And that assumes it's the physicians who should be making the decision - a position which itself is hardly obvious.

At the heart of the matter lies our uncertainty. We don't know what will happen tomorrow, or next week, or next year. So we do our best with what we have.

This uncertainty is the foundation of the entire human condition, isn't it. It's what medicine is about, but also politics, and history. It's what economics are about, and all ideologies and Weltanschauungen. If it isn't what literature and poetry are about, I can't think what is. And religion, of course. Cynics will say that religion is what gives unknowing people the tools with which to lull themselves into the ability to make decisions by comforting them that they're correct. Respecters of religion will say that it gives people the dignity to live with their decisions, whatever they might be.

6 comments:

A. Kramer said...

All of our big decisions are made with less than complete information. It is maddening and painful and real.

Anonymous said...

The opposite of certainty is fear.We are scared by any kind of uncertainty,tho it might be a chance to get another perspective, a change.
It's not uncertainty that makes us human.It's the one situation that offers a chance, and it takes a mensh to see, and react. There's no certainty but us.We do know,we do feel.We are to trust ourselves - that's the heart of religion.And life, and literature.Go ahead!

Anonymous said...

The opposite of certainty is fear.We are scared by any kind of uncertainty,tho it might be a chance to get another perspective, a change.
It's not uncertainty that makes us human.It's the one situation that offers a chance, and it takes a mensh to see, and react. There's no certainty but us.We do know,we do feel.We are to trust ourselves - that's the heart of religion.And life, and literature.Go ahead!

Lydia McGrew said...

"Probability is indeed the very guide of life."

Bishop Butler

Not that that helps very much. But I think the good Bishop's point was that it is possible to be rational even in circumstances of incomplete information, which is of course almost all circumstances.

The difficulty is that in a situation like the one you're describing, there are always the two different things: 1) The probability that such-and-such is going to happen. This part concerns empirical facts, data. If we do X, what is the likelihood that Y will occur--whether Y is a desired effect or a side effect. 2) What philosophers call your "utilities," meaning *how important it is to you* that Y happen or not happen, that you avoid Z, and so forth.

The reason the doctor can't make the decision is because he can be an expert on #1, but he isn't an "expert" on #2. The patient and his family have to decide what their utilities are. How important is it to them to live this long, to avoid these side effects, to give it the best try, etc., etc.? The doctor's expertise in medicine gives him no special right to substitute his utilities for the patient's. This is not to say that some versions of #2 aren't more or less reasonable than others but merely to say that doctors don't have any special line on the most reasonable ways of looking at what's most important.

Very probably the differences among the experts arise from their having different utilities. Which just throws the decision back on the patient and family, I'm afraid.

This person is in my prayers.

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Herman I. Levin said...

My wife, a former member of the Summer Institute and an admirer of yours has asked me to blog on your blog titled Uncertainty. Where you are with a loved one, I have been with my wife on three separate occasions within the last twenty years. She thinks I have something to say. Ergo: Indeed the uncertainty of making a decision regarding medical treatment does tend to preoccupy. Which professional's advice does one follow? However,this is not the uncertainty that causes the anxiety,the fear, even the terror. It is the uncertainty of life or death that brings up overwhelming emotions. If the worst happens: How will I go on without her? Religion, as you say,may provide a certain solace and a certain framework to understand what is happening. But even the most religious must experience the anxiety of uncertainty and potential loss that faces the problem of dealing with cancer.

Regardless of which professional's advice you choose, I can assure you, you will have your complaints and regrets. Hopefully, tbe outcome will be a positive one and the regrets minor ones.

I wish you and your loved one the same positive outcome that occured for me and my wife. I also wish you peace, serenity and a long healthy life.